Pneumatic Displacement of Submacular Hemorrhage of Different Etiologies With 40 Degrees Gaze-Down Position

Abstract

Purpose: : To evaluate a technique described by Lincoff for pneumatic displacement of subretinal macular hemorrhage of different etiologies based on the geometrical conclusion that gravity is the principal force acting to displace the hemorrhage.

Methods: : The eyes of 7 consecutive patients with recent subretinal hemorrhage in the macula due to different pathologies were given two intravitreal injections of perfluorocarbon gas (0.4cc of SF6 100% each, applied on consecutive days) sufficient for the expanded volume to cover the macula when the patient gazed down 40º below the horizontal. They were asked to maintain the gaze down position for 40 minutes every hour while awake for five days.

Results: : A bubble covering the macula in the gaze down position was achieved in all patients. The subretinal hemorrhage was displaced during the first week in all patients. Visual acuity improved in 6 of 7 patients (mean 13.5 lines SD ±9.8).

Conclusions: : This is a feasible technique based on the observation that it was well tolerated, a proper bubble was achieved, the hemorrhage was adequately displaced in a short period of time and vision improved in most patients. The 40 degrees position may be more comfortable for the patient resulting in better compliance. As stated by Lincoff, gravity may be the acting force in displacement of the hemorrhage.

Keywords: retina • vitreoretinal surgery • age-related macular degeneration