Surgical Treatment of Hemorrhagic Complications of Age-Related Macular Degeneration, Predictive Factors and Outcomes

Abstract Purpose The objective of this study was to evaluate the functional and clinical outcome of submacular hemorrhage in age-related macular degeneration (ARMD) using pneumatic displacement with intravitreal expansile gas by 23Gauge pars plana vitrectomy with subretinal injection of recombinant tissue plasminogen activator (rtPA) 50 mg in 0.1 ml. Patients and Methods Retrospective interventional case series of 58 pseudophakic patients, who underwent surgical treatment with inclusion criteria: subretinal, subretinal pigment epithelium (subRPE), or combined central hemorrhage associated with ARMD, 23 Gauge pars plana vitrectomy using rtPA sulfur hexafluoride (SF6 20%). Medical records were reviewed for logMAR best corrected visual acuity (BCVA), clinical findings, complications, and medical history up to 6 months after surgery. Results Patients were classified with small hemorrhage up to 2 × 2 papillary diameter (PD) in 32 eyes, moderate hemorrhage (up to 4 × 4PD, to the arcades) in 19 eyes and massive hemorrhage (from 5 × 5PD hemorrhage through the arcades to the periphery) in 7 eyes. Improvement of average postoperative BCVA was the best in the group with moderate extension of hemorrhage, 1.58 logMAR preoperative to 1.14 logMAR postoperative. Regarding the association between the hemorrhage category and clinical outcome, there was a significant positive association between the hemorrhage size before the operation and the scored clinical outcome. Conclusion Anticoagulants are associated with massive hemorrhage and, at the same time, with better postoperative BCVA than massive hemorrhage without total anticoagulant treatment.