Outcomes of subretinal macular hemorrhage treatment: a 7-year retrospective cohort study at Oslo University Hospital

Subretinal macular hemorrhage (SRMH) is a vision-threatening condition with no consensus on optimal treatment. This study evaluated the outcomes of five treatment modalities and their correlation with patient characteristics and optical coherence tomography findings. A retrospective review was conducted on 120 SRMH patients treated at Oslo University Hospital between October 24, 2015, and December 27, 2022. Best-corrected visual acuity (BCVA) was assessed before and 1-month after treatment. Statistical analyses were performed to evaluate the impact of treatment timing, hemorrhage size, and different therapeutic interventions on visual outcomes. Early intervention, particularly within 7 days of symptom onset, was associated with better median BCVA 1-month post-surgery. A 14-day cut-off showed no benefit. Patients with smaller hemorrhages (< 4500 μm) had significantly higher BCVA before treatment, but no statistical difference was observed 1-month after treatment. Combination therapies, including tissue plasminogen activator (tPA) with Sulfur Hexafluoride (SF6) gas and tPA with SF6 gas plus anti-vascular endothelial growth factor (anti-VEGF), resulted in significantly improved visual outcomes 1-month post-surgery, but no intervention outperformed others at the 1-month endpoint. Early intervention, particularly within 7 days of symptom onset, may improve visual outcomes in SRMH. Combined therapies involving tPA, gas and anti-VEGF appear to be more effective. Further studies with extended follow-up are needed to establish definitive treatment guidelines. This study highlights the importance of early intervention and individualized treatment strategies in managing SRMH. The findings contribute valuable insights into the effectiveness of combination therapies, offering guidance for clinicians and informing future research on evidence-based treatment guidelines.