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Case Reports
. 2021 May 18;5(2):23.
doi: 10.3390/vision5020023.

An Innovatory Surgical Technique for Submacular Hemorrhage Displacement by Means of a Bioengineering Perspective

George Pappas  1 , Nectarios Vidakis  2 , Markos Petousis  2 , Vasiliki Kounali  1 , Apostolos Korlos  3
Affiliations
Case Reports

An Innovatory Surgical Technique for Submacular Hemorrhage Displacement by Means of a Bioengineering Perspective

George Pappas et al. Vision (Basel). .

Abstract

The purpose of this case report is to present a new surgical technique for the treatment of large Subretinal Hemorrhage (SRH) secondary to Age-related Macular Degeneration (AMD). Considering the biomechanics of foam evolution theory, bubble coarsening effect, and gas-liquid biphasic absorption, an SRH due to an AMD case was treated with vitrectomy. The treatment was implemented by subretinal injection of air bubbles combined with rtPA followed by air fluid exchange. The air bubbles helped mess up and remove the blood from the macula area, and no complications occurred. Two weeks postoperatively, there was no sign of hemorrhage and the Central Macular Thickness (CMT) was sharply decreased from 443 μm to 317 μm. At the five-month follow-up, the CMT remained at 267 μm and the patient's visual acuity improved from light perception to 20/70 according to the Snellen chart. The combination of injecting multiple air bubbles and submacular rtPA, followed by air fluid exchange, was able to displace more than (90%) of the subretinal blood just two weeks postoperatively. Our technique is a promising alternative surgical approach for the displacement of SMH due to AMD, with a clear visual and anatomical benefit seen in the early follow-up period.

Keywords: Age-related Macular Degeneration (AMD); bioengineering; biphasic absorption; bubbles coarsening; subretinal hemorrhage (SRH); vitrectomy.

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Conflict of interest statement

The authors declare no conflict of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the General Hospital Venizelio or the Hellenic Mediterranean University.

Figures

Figure 1
Figure 1
Fundus picture (photos 1 and 2) of the patient’s left eye at first visit. A large submacular hemorrhage due to AMD is shown. The OCT (photo 3) indicates a CMT of 443 μm.
Figure 2
Figure 2
The key steps of the procedure followed. The graphics (a–c) illustrate a schematic representation of the procedure, while photos 1 to 5 depict the course of the procedure during the surgery, on the phase where air micro-bubbles are injected subretinally.
Figure 3
Figure 3
Photos 1 to 3 show the results of the treatment with the proposed procedure twelve days after the surgery, showing an impressive reduction in the CMT, while photos 4 to 6 show the long-term result of the treatment with the proposed procedure about five months after the surgery, indicating a normalization of the patient’s CMT.
See this image and copyright information in PMC

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