Minimally invasive surgery for subretinal hemorrhages associated with age-related macular degeneration

Purpose. To evaluate the efficacy and determine indications for minimally invasive surgery of subretinal hemorrhages in age-related macular degeneration. Material and methods. The study included 12 patients (12 eyes) with submacular hemorrhage (SMH) in age-related macular degeneration (AMD). All patients underwent minimally invasive surgery in the form of intravitreal injection (IVI) of anti-VEGF + IVI recombinant prourokinase + IVI ophthalmic gas (SF6, C2F6). The average duration of hemorrhage from its occurrence to the start of treatment was 15.6 ± 8.9 days (range, 6 to 30 days). The SMH size varied from 0.5 DD to 5 DD. Anti-VEGF therapy was performed in 4 (33.3 %) cases before the occurrence of SMH. The average follow-up period of patients after treatment was 13.6 ± 6.9 months (range from 6 months to 26 months). Results and discussion. With the maximum follow-up period after treatment, it was possible to achieve the displacement of the SMH: partial — in 6 (50 %) patients, complete — in 6 (50 %) patients. With the maximum follow-up period, an improvement in BCVA compared to preoperative was observed in 9 (75 %) cases, without dynamics — in 3 (25 %). In one case (8.3 %) after treatment at a period of 6 months, a relapse of SMH was observed, and it was larger than the original. All patients after the start of SMH treatment received anti-VEGF therapy. Conclusions. Minimally invasive surgery of SMH against the background of AMD has positive results in improving BCVA and displacing hemorrhage from the macular zone, subject to the patient selection criteria for treatment. Keywords: submacular hemorrhage, age-related macular degeneration, pneumodislocation, anti-VEGF inhibitors, recombinant prourokinase, tissue plasminogen activator