Surgical management of massive sub-macular hemorrhage associated with age-related macular degeneration

Abstract

Purpose: To investigate the safety and efficacy of surgical drainage of massive and elevated submacular hemorrhage associated with age-related macular degeneration through circumferential peripheral 180° temporal retinotomy. Methods: Prospective interventional case series of first eyes of six consecutive patients with large elevated submacular hemorrhage. The surgical approach consisted of combined cataract surgery, three-port pars plana vitrectomy, induction of retinal detachment, and circumferential peripheral temporal 180° retinotomy. The temporal retina was reflected and the solid blood clot was removed with a vitreous cutter along with the choroidal neovascular complex. Silicone oil was used as an internal temponade in all patients. Complete clinical examination was performed in all cases preoperatively and postoperatively at 1 and 3 months. After removal of silicone oil, the patients were observed for 12 months. Results: Submacular hemorrhage was completely removed in all cases the next day after the surgery. All patients experienced improvement of central scotoma. Twelve months after silicone oil removal, visual acuity was defined as improvement in 5 eyes (83%) and stable in 1 eye (17%). No recurrence or complications were observed during the period of follow-up. Conclusion: Our surgical approach could be efficacious to remove a large elevated submacular hemorrhage that is not feasible for any other treatment. It may help to improve the central scotoma and results in limited visual improvement in selected patients.