Massive Subretinal Hemorrhage

In this surgical video, Dr. Andre Witkin manages a massive subretinal hemorrhage in an 84-year-old monocular patient with hand motion vision in the right eye due to a previous massive subretinal hemorrhage and subsequent scar from neovascular AMD. She was receiving intravitreal aflibercept injections every 6 weeks in the left eye, and had stable vision until 1 week before she was due to receive her next injection. She presented with a massive subretinal hemorrhage and light perception vision in her left eye.

Dr. Witkin begins with a pars plana vitrectomy and injects subretinal tissue plasminogen activator (tPA). Air-fluid exchange was performed to localize the subretinal fluid posteriorly, followed by a retinotomy in the superior retina to access the subretinal space. The hemorrhage was gone by postoperative week 1 and her vision improved to counting fingers.

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