Posttraumatic submacular hemorrhage management witn pneumatic displacement only

Abstract

Submacular hemorrhage ( SMH) is one of the eye trauma (contusion) complications which lead to severe visual loss. Objectives: To study the results of SMH management with pneumatic displacement by perfl uoropropane gas (C3F8) without tPA and vitrectomy Methods: Retrospective, noncomparative, interventional case. The results of management of 75 consecutive patients (75 eyes) in the age 19–60 y/o with posttraumatic SMH were analyzed. The duration of hemorrhage duration was 1–12 days; size: 2–20 DD, thickness: 0.1–3.0 mm. In all patients visual acuity ( VA) was less than 0.1. In all cases the intravitreal injection of C3F8 (0.4–0.5 ml) was performed under topical instillation anesthesia. After surgery patients were instructed to maintain the position of head tilted slightly forward under 45° for 1–3 days. Results: The complete or partial displacement of SMH out of the fovea was observed next day after surgery in 72 eyes (96.0%). Only in 3 cases of thin SMH the hemorrhage thinning instead of its displacement was observed. In 60 cases SMH moved strictly inferiorly due to the correct optimal head position (tilted slightly forward under 45°) in postoperative period. Postoperative VA improved to more than 0.3 next day after surgery in 70.0% of cases (incl. in 7 patients to 0.5–0.7, in 5 to 0.85–1.0). No complications were observed in early and late postoperative period. The less improvement of VA was observed in cases with central choroidal rupture. Conclusions: Our 20 years’ study experience of pneumatic displacement of SMH with perfl uoropropane injection only is shown to be eff ective, safe and cost-eff ective procedure in management of SMH of any etiology incl. posttraumatic. It was shown that the more is the size and thickness of SMH the easier is its displacement from the macula. The postoperative head position tilted slightly forward under the angle 45° provides displacement of SMH strictly inferiorly.