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K.-S. Kim, J.-W. Jung, Y.-C. Kim; Management of Submacular Hemorrhage Associated With Retinal Pigment Epithelial Detachment. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2566.
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To assess the anatomic and functional results of surgical or nonsurgical management for submacular hemorrhage associated with retinal pigment epithelial detachment(RPED).
36 consecutive patients(36 eyes) with the thick submacular hemorrhage associated with RPED were treated by pneumatic displacement or pars plana vitrectomy(PPV) or both. Pneumatic displacement was performed with or without subretinal tissue plasminogen activator (tPA) injection. Surgical technique of PPV included a complete posterior vitrectomy, subretinal injection of tPA, puncture of RPED, evacuation of the liquefied blood into the vitreous cavity in help with perfluorocarbon liquid, with or without laser photocoagulation on the extrafoveal portion of RPED, and gas tamponade.
Follow-up ranged from 4 to 48 months(mean, 13.3 months). The median preoperative visual acuity(VA) was 20/250(range, 20/2000 to 20/70) compared to the median postoperative VA of 20/70(range, 20/500 to 20/30). The final VA was improved in 23(64%) of the 36 eyes, unchanged in 10(28%) eyes, and decreased in three(8%) eye. 10(28%) eyes had a final VA of 20/50 or better. Idiopathic cases revealed much better visual outcome compared to the age-related macular degeneration (AMD) patients (20/50 vs 20/100) (p<0.05). Most RPEDs were attached at the final examination. Prognostic factors associated with the worse visual outcome include AMD, the presence of subfoveal neovascular membrane and the longer duration of subretinal hemorrhage.
Surgical and/or nonsurgical management may be benefit to patients with submacular hemorrhage associated with RPED.
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