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. 2016 Oct-Dec;30(4):221-226.
doi: 10.1016/j.sjopt.2016.10.002. Epub 2016 Oct 13.

Pneumatic displacement of submacular haemorrhage

Ehab Abdelkader  1 , Kay P Yip  2 , Kurt Spiteri Cornish  3
Affiliations

Pneumatic displacement of submacular haemorrhage

Ehab Abdelkader et al. Saudi J Ophthalmol. 2016 Oct-Dec.

Abstract

Purpose: To evaluate the outcomes of pneumatic displacement of submacular hemorrhage secondary to choroidal neovascular membrane (CNV) (n = 9) and retinal arterial macroaneurysm (RAM) (n = 3).

Methods: This is a retrospective case series study of 12 eyes from 12 patients in Aberdeen Royal Infirmary, Aberdeen, UK. The mean duration of visual loss was 10.8 ± 4.11 days. All cases received intravitreal injection of expansile gas within 24 h of presentation (C3F8 in 11 cases and SF6 in one case) and postured face down for five days. Anterior chamber paracentesis was done right after gas injection. Intravitreal anti-VEGF was injected at the same time in cases with CNV. Further anti-VEGF injections were done in CNV cases as needed afterwards. Cases were followed up for 6 months.

Results: The submacular hemorrhage was successfully displaced from underneath the fovea in all but one case. The bleeding disappeared totally in 44% of cases and was inferiorly displaced in 56%. VA improvement at 6 months was statistically significantly higher than baseline VA. All cases but 2 (one because of subfoveal fibrosis and one because of late presentation) experienced improved VA. The mean VA improved from 1.37 ± 0.18 logMAR at baseline to 0.83 ± 0.26 logMAR at 6 months. No complication related to the procedure was reported.

Conclusion: Pneumatic displacement of submacular hemorrhage appears to be a safe and effective technique to treat the condition. It is an easy procedure that can be done in outpatient setting. Further studies are needed to validate our results.

Keywords: CNV; Exudative AMD; Pneumatic displacement; Retinal arterial macroaneurysm; Submacular hemorrhage.

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Figures

Figure 1
Figure 1
Colour fundus photographs and OCT images of a case of SMH secondary to RAM successfully treated with intravitreal gas injection. (A) Colour photograph at presentation. (B) OCT at presentation. (C) Colour photograph at 1 month follow-up. (D) OCT at one month follow-up. (E) Colour photograph at 6 months. (F) OCT at 6 months.
Figure 2
Figure 2
Colour photographs and angiography of a case of SMH secondary to exudative AMD successfully treated with intravitreal C3F8 injection + Lucentis injections. (A) Colour photograph at baseline. (B) FFA at baseline. (C) Colour photographs at 3 months follow-up (post gas and 3 lucentis injections). (D) ICG at 3 months showing a small residual hyperfluorescent spot due to RAP lesion (arrow). (E) Colour photograph at 6 months showing complete resolution of the lesion. (F) ICG at 6 months showing no residual hyperfluorescence.
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