June 2015
Volume 56, Issue 7
ARVO Annual Meeting Abstract  |   June 2015
Pneumatic Displacement of Submacular Hemorhage due to Neovascular Age related Macular Degeneration (AMD)
Author Affiliations & Notes
  • Khalid Samer Kahook
    Ophthalmology, Henry Ford Hospital, Detroit, MI
  • Hua Gao
    Ophthalmology, Henry Ford Hospital, Detroit, MI
  • Footnotes
    Commercial Relationships Khalid Kahook, None; Hua Gao, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2856. doi:
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      Khalid Samer Kahook, Hua Gao; Pneumatic Displacement of Submacular Hemorhage due to Neovascular Age related Macular Degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2856.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: Submacular hemorrhage in patients with neovascular AMD often leads to sudden, severe, irreversible vision loss due to photoreceptor toxicity. Our purpose is to evaluate the effectiveness of pneumatic displacement (PD) of submacular hemorrhage for treatment of this vision threatening disorder.

Methods: This is a retrospective study of patients with submacular hemorrhage due to neovascular AMD who have undergone PD for treatment. Patients received intravitreal SF6 gas (0.4 mL-0.5mL) and were instructed to remain in strict head down positioning for 24 hours. They then received anti-VEGF therapy the following day and serially as needed. Data collected included age, symptom onset time to presentation, presenting and final visual acuity, presenting and final central retinal thickness (CRT) using SD-OCT, color fundus photo and fluorescein angiography, size and thickness of submacular hemorrhage, total number of anti-VEGF injections, follow up time and any side effects or complications.

Results: We evaluated 6 eyes from 6 patients. The mean age of patients was 74 years. On average, patients presented 6.2 days (range 3-10 days) after symptom onset. At presentation mean visual acuity was 20/100 and CRT was 391 μm. These patients presented with thin, less than 1 mm thick, up to 3 disc diameter in size, center-involved submacular hemorrhage. All patients received one SF6 gas injection on initial presentation and anti-VEGF therapy the following day. On average, the patients received 6.7 anti-VEGF injections with a mean follow up time of 19 months (range 5-39 months). Mean visual acuity at final presentation was 20/40 with an average improvement in CRT of 132 μm. The next day the patients were examined and the submacular hemorrhage was mostly displaced inferiorly and the residual hemorrhage was later absorbed. 1 patient required a vitrectomy to obtain a larger air bubble because he was physically unable to keep strict head down positioning due to chronic neck problems. There were no incidents of endopthalmitis, vitreous hemorrhage, retinal detachment, or recurrent hemorrhage.

Conclusions: Pneumatic displacement with intravitreal gas injection in combination with anti-VEGF therapy is a simple, convenient in-office procedure for submacular hemorrhage due to neovascular AMD. Patient selection is important as patients must maintain strict positioning and early treatment is critical.


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