Submacular hemorrhage: A study amongst Indian eyes

Abstract

Aim:To evaluate the management outcomes amongst various treatment modalities for submacular hemorrhage (SMH) in Indian subjects.Settings and Design:Retrospective, single-center study.Materials and Methods:Patients presenting with SMH between 1999 and 2006 were included. Treatment modalities included: vitrectomy with subretinal recombinant tissue plasminogen activator (r-tPA) assisted SMH evacuation (group 1, n = 14); pneumatic displacement with intravitreal r-tPA and gas (group 2, n = 25); and pneumatic displacement with intraocular gas (group 3, n = 7). Favorable anatomical outcome was defined as complete displacement of SMH from fovea and favorable functional outcome was defined as a gain of >2 Snellen lines from the baseline. Kruskal–Wallis, analysis of variance (ANOVA), and Chi-square tests were used to compare the three groups, while Mann–Whitney and independent t-test were used to evaluate the influence of duration and size of SMH on outcomes.Results:There was no difference amongst groups in terms of favorable anatomical (P = 0.121) or functional outcomes (P = 0.611). Eyes with median duration of SMH less than 7.5 days had a significantly higher probability of achieving favorable anatomical outcome compared to eyes with SMH >14.5 days (P = 0.042). However, duration of SMH did not influence functional outcome (P = 0.595). Similarly, size of SMH did not affect anatomical (P = 0.578) or functional (P = 0.381) outcome. Median follow-up was 31.5, 6.5, and 2.5 months in the three groups, respectively.Conclusions:Co- existing posterior segment conditions and duration of SMH may influence the choice of treatment modality and treatment outcomes. Pneumatic displacement with r-tPA and r-tPA assisted vitrectomy appear to be favorable options for the management of SMH.

Visual prognosis of massive submacular hemorrhage in polypoidal choroidal vasculopathy with or without combination treatment

“…2,3,13,17,20 In our study, we found that good initial BCVA, small initial size of submacular hemorrhage and young age were statistically significant predictors for better visual prognosis. Other factors such as sex, hypertension, duration of hemorrhage, and presence of RPE detachment did not influence the outcome.…”

“…5,7,8,17 PCV and massive submacular hemorrhage were risk factors for developing VH. 7,8 In our study, the only complication was VH at an incidence of 10%, which was lower than the 15% reported by Wu et al 8 There were no risk factors found to be associated with the occurrence of VH, which also did not affect the visual prognosis.…”

Idiopathic macular telangiectasia type 1 with ruptured retinal arterial macroaneurysm post intravitreal bevacizumab

“… 4 Pneumatic displacement of large submacular hemorrhages with adjunctive intravitreal tissue plasminogen activator has been described and is best effective within less than 10 days from occurrence of symptoms. 5 …”

Retinal Penetration of Intravitreally Injected Tissue Plasminogen Activator: A Rat Model Study

“…Some recent reports [40][41][42] even suggest that intravitreal injection of tPA and gas without vitrectomy may be as effective in reducing blood volume as submacular injection of tPA with vitrectomy. Treatment with intravitreal tPA has also been reported to yield better functional and anatomic outcomes than pneumatic displacement alone [40].…”