Displacing a Large Submacular Hemorrhage

Large thick submacular hemorrhage is a rare complication of neovascular AMD. Although there is no consensus on optimal management, vitrectomy with tissue plasminogen activator (tPA)-assisted pneumatic displacement can displace the hemorrhage from the submacular space. The technique is particularly effective if performed within 7 days from the time the hemorrhage occurred. The addition of subretinal air can assist in inferior displacement of the hemorrhage via its buoyant force. A partial gas fill and postoperative upright positioning allow the majority of hemorrhage to be displaced out of the macula by 1 week after surgery. At 1-week postop, this patient’s vision was 20/250. These patients often need ongoing monthly anti-VEGF injections after surgery.

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