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Transretinal resection of submacular hemorrhage

DOI: 10.5677/2010-1-1

Submitted by: Alireza Mirshahi, MD, FEBO

Several methods have been introduced for the treatment of submacular hemorrhages secondary to age-related macular degeneration. Small bleeds may be dislocated by intravitreal injection of SF6 gas, possibly combined with recombinant tissue plasminogen activator (rTPA). Larger hemorrhages can be treated by pars plana vitrectomy, subretinal injection of rTPA and gas tamponade. Large and particularly thick bleeds may require additional procedures such as subretinal lavage or the surgical removal of blood clots. Moreover, macular translocation surgery with blood removal may be appropriate. This video illustrates a surgical method for removing large and thick subretinal hemorrhages by pars plana vitrectomy, retinotomy and transretinal resection of the hemorrhage followed by silicone oil tamponade. (Intravitreal injection of SF6 gas had been ineffective in this patient). Visual acuity improved from hand motion before surgery to postoperative 20/100. Treatment options and potential complications of this surgical method must be discussed with the patient individually.

Keywords: Submacular hemorrhage, macular degeneration, pars plana vitrectomy.

References:
1) Fine HF, Iranmanesh R, Del Priore LV, et al. Surgical outcomes after massive subretinal hemorrhage secondary to age-related macular degeneration. Retina. 2010;30(10):1588-94
2) Kamei M, Tano Y. Tissue plasminogen activator-assisted vitrectomy: surgical drainage of submacular hemorrhage. Dev Ophthalmol. 2009;44:82-8
3) Bressler NM, Bressler SB, Childs AL, et al. Surgery for hemorrhagic choroidal neovascular lesions of age-related macular degeneration: ophthalmic findings: SST report no. 13. Ophthalmology. 2004;111(11):1993-2006
4) Höhn F, Mirshahi A, Hattenbach LO. Combined intravitreal injection of bevacizumab and SF6 gas for treatment of submacular hemorrhage secondary to age-related macular degeneration. Ophthalmologe. 2010;107(4):328-32

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