gms | German Medical Science

22nd Annual Meeting of the German Retina Society

German Retina Society

26.06. - 27.06.2009, Berlin

Submacular Surgery: Currently remaining indications

Meeting Abstract

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  • Bernd Kirchhof - University Eye Clinic of Cologne

German Retina Society. 22nd Annual Meeting of the German Retina Society. Berlin, 26.-27.06.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocRG2009-06

doi: 10.3205/09rg06, urn:nbn:de:0183-09rg060

This is the translated version of the article.
The original version can be found at:

Published: June 29, 2009

© 2009 Kirchhof.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Due to the risk of surgery – not due to costs – submacular surgery should be confined to indications outside intravitreal Injections.

This includes:

Non-Responders to VEGF-Blockade
Pigmentepithelium rupture (selected cases)
Massive subretinal hemorrhage
Geographic Atrophy (early stage)

In my opinion a non-responder should be characterized as an eye under VEGF-blockage that looses at least 5 letters, in conjunction with a fresh choroidal neovascularisation. The leakage may persist or may be followed by submacular fibrosis. RPE-ruptues or massive submacular hemorrhages may imitate a non-responder. In general the non-responder is being identified rather late, rendering alternative (surgical) interventions ineffective.

An RPE-rupture leaving the fovea unsupported leaves no other choice than pigment cell translocation and may at best allow visual improvement.

Massive submacular hemorrhage is a likely indication to surgery, when displacement by a gas bubble is considered as impossible.

Geographic atrophy may be an indication to surgery, when it is progressiv, and when there is useful remaining vision (central fixation). In this case stabilisation of central vision would mean a prognostic improvement to the patient.