Clinical Course of Submacular Hemorrhage Due to Various Chorioretinal Diseases According to Pneumatic Displacement

PURPOSE: To assess the clinical course of submacular hemorrhage (SMH) due to various chorioretinal diseases with or without pneumatic displacement and the factors related with the final visual outcome. METHODS: The authors of the present study retrospectively reviewed the charts of 12 eyes (group 1) which underwent pneumatic displacement for SMH and the charts of 14 eyes (group 2) which did not receive pneumatic displacement. Best-corrected visual acuity (BCVA) at baseline was compared with the BCVA at 1, 3, and 6 months and on the final visit. Association between final BCVA and other clinical features was analyzed including age, baseline BCVA, duration of symptoms, and size of SMH. RESULTS: In group 1, log MAR BCVA was 1.22 +/- 0.66 at baseline and there was a significant BCVA improvement of 0.77 +/- 0.57 at 6 months compared with baseline (p = 0.045). On the final visit, 6 eyes (50%) had gained 2 Snellen lines or more. In group 2, BCVA was significantly improved from 1.29 +/- 0.70 at baseline to 1.06 +/- 0.84 at 1 month (p = 0.045). Ten eyes (71.4%) had gained 2 Snellen lines or more on the final visit. In group 1, there were no factors correlated with final BCVA (p > 0.05), while the final BCVA was significantly correlated with age and baseline BCVA in group 2. CONCLUSIONS: Clinicians may expect conservative treatment to lead to significant improvement of BCVA in patients with SMH due to various chorioretinal diseases who did not undergo any procedures to displace the hemorrhage.

Pneumatic displacement without tissue plasminogen activator in premacular subhyaloid hemorrhage.

To assess the efficacy and safety of intravitreal injection of Sulfur Hexafluoride (SF6) gas without the use of tissue Plasminogen Activator (tPA) in premacular Subhyaloid Hemorrhage (SHH), 5 eyes of 5 patients with premacular SHH were enrolled. After performing paracentesis of the anterior chamber, 0.3 ml pure SF6 gas was injected through pars plana with a 30 gauge needle. Facedown position was maintained for 5 days. Subhyaloid Hemorrhage was displaced in 4/5 (80%) eyes with a duration of SHH less than 2 weeks. The pre-injection visual acuity of all 5 eyes was finger counting and improved in 4/5 ( 80% ) eyes within 3 days to 7 days post-injection to 6/20 - 6/6. The underlying disease was hypercoagulation in 1 patient, diabetes mellitus in 2 patients, hypertension in 1 patient and unknown in 1 patient. No complications were encountered. In conclusion, SF6 gas injected into the vitreous without the use of tPA, can displace SHH if performed within 14 days of duration, and results in rapid visual recovery. This procedure is proven to be safe.

Pneumatic Displacement of Submacular Hemorrhage with Intravitreal Injection of SF6 Gas without Tissue Plasminogen Activator

PURPOSE: To assess the efficacy and safety of intravitreal injection of SF6 gas for the displacement of submacular hemorrhage without use of tissue plasminogen activator (tPA) METHODS: Three hundred microliter of pure SF6 gas 0.3 ml was injected into the vitreous cavity in 9 eyes with submacular hemorrhage involving the fovea because of myopic degeneration (3 eyes), trauma (3 eyes), age-related macular degeneration (2 eyes), macroaneurysm (1 eyes), branch retinal vein occlusion (1 eyes) and myopic degeneration (2 eyes) within 4 weeks after the onset of symptoms. The patients were instructed to maintain a prone position for less than 7 days. RESULTS: Initial visual acuity was ranged from hand motion to 0.2 and visual improvement was found in 7 eyes on the 7th day after the gas injection. On the 7th day after the gas injection, submacular hemorrhage was completely displaced in 2 eyes and slightly displaced with a reduction in the thickness of hemorrhage in 2 eyes. Transient elevation of intraocular pressure occured in 1 eye and was successfully controlled with medications. CONCLUSIONS: Intravitreal SF6 gas injection is simple and can displace submacular hemorrhage without use of tissue plasminogen activator in many cases with no serious complications.