Results of surgical treatment of macular hemorrhages

Rationale: Submacular hemorrhage (SMH) is a rare complication of choroidal or retinal vascular abnormalities, including choroidal neovascularization (CNV), polypoid choroidal vasculopathy (PCV), and retinal macroaneurysm (RMA). Of these, polypoid choroidal vasculopathy is the condition most commonly associated with large SMH (20% to 63% of eyes with PCV). SMH can damage photoreceptors as a result of iron-induced toxicity with irreversible retinal damage occurring as early as 24 hours after the onset of hemorrhage. Objective: To evaluate the results of various methods of surgical treatment of macular subretinal hemorrhage in two clinical cases. Methods: 4 patients (two in each group) with submacular hemorrhage were included in our study. All patients underwent a standard ophthalmological examination: visometry, tonometry, optical coherence tomography. Two methods of surgical treatment were used: pars plana vitrectomy (PPV) + peeling of the internal limiting membrane (ILM) + subretinal injection of recombinant tissue plasminogen activator (rtPA) ("Gemaza”) and PPV + ILM peeling + subretinal injection of rtPA + subretinal injection of air. Recombinant tissue plasminogen activator is a lyophilized enzyme preparation that is susceptible to recombinant prourokinase and catalyzes the conversion of plasminogen into plasmin, capable of lysing fibrin clots, and has exceptional specificity of action, since it activates plasminogen mainly in the clot area, which is unlikely to cause bleeding and hemorrhage. Results: PPV + subretinal injection of rtPA is an effective treatment for SMH. In both clinical cases, resorption of hemorrhagic contents occurred. In the first case, with the restoration of the retinal profile in the macula and an increase in visual acuity to 0.16. In the second case, with subretinal air injection, visual acuity did not change, since a macular hole was formed, which must be taken into account when choosing this method of treatment and should be used with caution. Ultimately, visual acuity increased to 0.05. Low visual acuity in both cases, in our opinion, may be due to hemorrhagic detachment of the neuroepithelium in the macula. Conclusion: Our results, in the 2nd clinical case, confirmed the literature data that subretinal air injection can lead to the formation of a macular hole. Although SMH can be difficult to treat, reasonable visual results can be achieved with timely and appropriate intervention.