Efficacy of pneumatic displacement of sub macular haemorrhage (SMH) secondary to wet age related macular degeneration (ARMD)

Abstract

 

Purpose

 

Sub macular haemorrhage associated with wet ARMD is a complication known to have potentially devastating effects on visual acuity. Various techniques for its displacement have been described in the literature. However, there remains no consensus on optimal treatment as clinical trials for wet ARMD have excluded patients with SMH. We evaluated the efficacy and safety of intravitreal SF6 and repeated intravitreal Lucentis injections for the resolution of SMH.

 

Methods

 

Prospective analysis was done of eight patients of SMH treated with intravitreal injection of 0.1-0.5 ml of 100% SF6 gas and 0.5mg Lucentis injections with anterior chamber paracentesis from November 2011 to August 2012. Patients were postured in a prone position for two weeks. Further treatment with intravitreal Lucentis was continued as required on the basis of clinical and OCT (Optical coherence tomography) findings.

 

Results

 

SMH was completely displaced in 7 and partially displaced in 1 out of 8 patients. Visual acuity (VA) improved in 4, stable in 2 and decreased in 2 patients due to sub retinal fibrosis. Mean pre-operative VA of 33.4 letters on the LOGMAR chart improved to 38.9 letters post operatively with mean VA improvement of 5.5 letters (p value 0.59). There were 6 women and 2 men with an average age of 77 years (range from 54 years to 95 years). The type of lesion was minimally classic in four patients, classic in two and was not known in two patients. The size of the lesion ranged from 1.5 disc diameters to 6 disc diameters. Two patients developed high intraocular pressure which was controlled with a stat dose of Acetazolamide. There were no other complications. Average follow up was 6 months (range from 3 to 12 months).

 

Conclusions

 

SMH can be successfully and safely treated with intravitreal SF6 and Lucentis injections. Success of treatment depends on the size of the haemorrhage. Its efficacy is comparable to extensive procedures involving vitrectomy and sub macular surgeries.

 

 

Pre-operative (top picture) and 3 months post-operative (bottom picture) colour fundus photograph of the left eye of a patient with sub retinal haemorrhage treated with intravitreal SF6 and Lucentis injections

 

Keywords: 412 age-related macular degeneration • 748 vascular endothelial growth factor • 764 vitreous substitutes