gms | German Medical Science

To study the efficacy of traumatic submacular hemorrhage management with pneumatic displacement by perfluoropropane injection.

The results of treatment of 30 consecutive patients (31 eyes) in the age 27,9± 8,3 years with eye injury (closed globe, contusion - by BETT) and submacular hemorrhage were analyzed. Duration of hemorrhage was 1 - 30 days (12,1±7,7), size: 2 –20 DD (6,2±3,5), thickness: 0,4 - 3,0 mm (1,0±0,7). VA was less than 0,1 in all patients. All patients received intravitreous injection of 0,5 – 0,6 ml of pure perfluoropropane gas ("Alcon") without tPA before. After surgery patients was recommended to maintain the position of head tilted slightly forward under the angle 45º for 1 – 3 days. The instillations of "Tobradex" ("Alcon") or "Floxal" (Bausch & Lomb) and "Maxidex" ("Alcon") eye drops 4 times per day for 3 days was indicated.

In all 31cases the complete or partial displacement of submacular hemorrhage out of the foveal area was observed on the next day after surgery. In the majority of cases (89,0%) the hemorrhage moved inferiorly. Postoperative visual acuity improved up to 0,5 -0,7 in 11 cases (35,4%), to 0,35 - 0,4 in 8 cases (26%), to 0,85 -1,0 in 3 cases (9,7%) on the next day after surgery. Less significant visual acuity improvement (up to 0,1 – 0,3) in 9 cases (29%) was observed in patients with central choroidal rupture. There were no any complications in each case after surgery. The follow-up study (2 years) showed the stability of functional and anatomical results obtained.

Intravitreous injection of perfluoropropane gas only is effective in displacing of traumatic submacular hemorhage out of the macular area and improving and accelerating visual recovery in such patients. The postoperative head position under the angle 45º is of value to provide the complete displacement of subretinal hemorrhage to the inferior direction in the majority of cases and prevents lens opasification due to contact with gas bubble.