Minimally Invasive Surgical Treatment of Macular Hemorrhages
To date, there is overwhelming evidence that the intravitreal administration of rt-PA, anti-VEGF agents, and hexafluoride gas has the potential to improve vision or delay the progression of visual loss in patients with submacular hemorrhage.
Core vitrectomy has an additional beneficial effect and may be combined with the intravitreal injection of drugs. The complication rate of this minimally invasive technique seems to be low.
Time to treatment and hemorrhage size are among the characteristics that significantly affect the outcome. Early minimally invasive intervention provides a better chance for prompt recovery of useful vision in patients with recent onset (≤14 days) of subretinal hemorrhage. This advantage appears to be clearly present in the eyes with small (≤2 disc areas) subfoveal hemorrhages.
In the vast majority of cases, subretinal hemorrhage is associated with exudative age-related macular degeneration and therefore requires continued postoperative treatment with anti-VEGF agents. Successful displacement of submacular blood may yield a rapid visual rehabilitation, presumably helps prevent further damage to the neurosensory retina, and provides better chances for a successful treatment of underlying choroidal neovascular membranes with anti-VEGF agents.
Early core vitrectomy and pneumatic displacement are reasonable treatment alternatives in patients with subretinal or subhyaloidal hemorrhage secondary to underlying conditions other than AMD such as retinal macroaneurysms.
Small subretinal hemorrhages (≤2 disc areas) associated with choroidal neovascularization secondary to age-related macular degeneration respond well to anti-VEGF monotherapy.
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