gms | German Medical Science

To study the efficacy and safety of submacular hemorrhage (SMH) of various etiology displacement with intravitreal injection of perfluoropropane (C₃F₈) gas only.

Retrospective, noncomparative, interventional case series. There were analyzed the results of treatment of 47 consecutive patients (48 eyes) in the age 19-75 y/o with SMH. Etiology of SMH were following: eye trauma - 31 eyes, ARMD – 12, high myopia – 2, scleral buckling procedure – 2, arterial hypertension – 1 eye. Duration of hemorrhage was 1 - 40 days (12,3±8,7SD), size: 2 –20 DD (6,1±3,7SD), thickness: 0,1 - 3,0 mm (0,8±0,7SD). Visual acuity (VA) was less than 0,1 in all patients. Intravitreous injection of 0,5 – 0,6ml of C₃F₈ (“Alcon”) was performed in all cases. After surgery patients maintained the position of head tilted slightly forward under 45º for 1 – 3 days. The instillation of “Tobradex” (“Alcon”) or "Floxal" ("Bausch & Lomb) and "Maxidex"(“Alcon”) 4 times during the day was recommended.

The complete or partial displacement of SMH out of the fovea was observed next day after procedure in almost all of the cases (46 eyes). In 38 cases (79,2%) the SMH moved inferiorly. Just only in 2 cases of the most small and thin SMH only thinning of it was observed. It was founded that the more is the size and thickness of SMH the more is its degree of displacement from the macula. In one case of ARMD the displacement of large exudate was observed. Postoperative VA improved up to more than 0,3 next day after surgery in 26 cases (54,1 %) (incl. in 6 patients to 0,5-0,7, in 4 to 0,85-1,0). No any complications in each case after surgery. Follow-up study (up to 3 years) showed the stability of results obtained.

So, intravitreous injection of pure perfluoropropane gas without tPA is effective, safe and not expensive procedure in displacing submacular blood and, so, is very useful for an avoidance of toxic effect of subretinal blood and improved and accelerated visual recovery in patients with submacular hemorrhage of different etiology. In the cases of ARMD this procedure also promotes the reduction of edema and exudation and give the possibility for the earliest application of PDT or TTT. The postoperative head position under the angle 45º is very important to provide the displacement of subretinal hemorrhage to the inferior direction in the majority of cases and prevents lens opasification due to contact with gas bubble.