Pneumatic Displacement of Submacular Hemorrhage Due to Choroidal Rupture

Abstract

Abstract: : Purpose:To examine the clinical outcome of pneumatic displacement of submacular hemorrhage secondary to traumatic choroidal rupture. Methods:This is an interventional case series studying four patients who presented with decreased vision and submacular hemorrhage following eye trauma. The ages of the patients ranged from 23 to 40 years. The patients presented with visual acuities from 20/400 to 2/200. An afferent pupillary defect present in one of the patients was assessed to be secondary to traumatic optic neuropathy. All four patients had thick (> than 1mm) submacular hemorrhage with an associated choroidal rupture. These patients were treated with pneumatic displacement of submacular hemorrhage within four days of their trauma. Three of the patients underwent pars plana vitrectomy with posterior hyaloid stripping and air fluid exchange. A fourth patient was treated with intravitreal injection of 100 µg tissue plasminogen activator (t-PA) and 0.3cc of 100% C₃F₈. Face down positioning was advised for one week. Fluorescein angiography was performed pre- and post-operatively on all patients. Results:Post-operatively, all patients showed displacement of subfoveal hemorrhage. The hemorrhage was maximally displaced in the patient who received intravitreal t-PA and C₃F₈. Post-operative examination and fluorescein angiography revealed the choroidal rupture to be within 1500 microns of the foveal center in all cases. Best post-operative visual acuity in the three patients followed for more than 2 weeks ranged from 20/25 to 20/50. The follow-up time ranged from 2 weeks to 17 months (one patient was incarcerated and lost to follow-up). No surgical complications or incidences of re-bleeding were observed during the follow-up period. Conclusions:Pneumatic displacement of submacular hemorrhage is an effective treatment in patients with traumatic choroidal rupture. Significant recovery of visual acuity can occur in patients with thick subretinal hemorrhage and a choroidal rupture passing near the foveal center, warranting emergent pneumatic displacement for this condition. Patients in this series showed similar visual improvement when treated with either pars plana vitrectomy / hyaloid stripping and air-fluid exchange or intravitreal placement of an expansile gas and t-PA.

Keywords: choroid • trauma • retina