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Robert Wirthlin, Harrison Robert Jones; Pneumatic displacement of submacular hemorrhage: single surgeon consecutive case series. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1936.
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© ARVO (1962-2015); The Authors (2016-present)
Controversy exists in treating submacular hemorrhage. Options include observation, pneumatic displacement, and pars plana vitrectomy with subretinal injection of tissue plaminogen activator and air-fluid exchange. Observation has a poor visual prognosis for several reasons: toxicity of blood breakdown products, a physical barrier between the chorioriocapillaris/RPE and neurosensory retina, and disciform scarring. However, pars plana vitrectomy with subretinal tPA injection carries well-known significant treatment-associated risks. We performed a retrospective review of outcomes for pneumatic displacement by a single surgeon over a three year period.
We reviewed our electronic health record from 2013 to 2016 to indentify patients who underwent any gas bubble injection. Subjects were found by searching the for CPT codes 67110 and 67025. Eighteen were identified. Eleven subjects whose procedure was performed to treat a rhegmatogenous retinal detachment were excluded. Six subjects whose procedure was performed to treat subretinal hemorrhage and who had at least 3 months of follow up were included. One subject excluded due to lack of follow up. Treatment consisted of a single intravitreal injection of 0.3 cc of C3F8 through the pars plana followed by part time positioning for one week. Information gathered included age, visual acuity, diagnosis, other interventions, central one mm macular subfield thickness by OCT, diagnosis, area of hemorrhage on fundus photography and treatment complications.
The cause of submacular hemorrhage was exudative age-related macular degeneration (wet AMD) in 4 patients and retinal macroaneurysm (MA) in 2 patients. Average age was 80.8 years. Mean visual acuity measured 20/400 and 20/60 at baseline and follow up (mean 13 months), respectively. OCT measured 533 microns and 357 microns, at baseline and post treatment, respectively. Average baseline subretinal hemorrhage area measured 25 mm2. Patient with wet AMD were treated with anti-vascular endothelial growth factor (VEGF) agents for the duration of the study. Patients with MA were treated with monthly anti-VEGF until resorption of subretinal hemorrhage. There were no treatment-associated complications.
In our small case series, pneumatic displacement followed by treatment of the underlying disease effectively improved visual acuity and reduced macular thickness without any complications.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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