Surgical Management of Subretinal Hemorrhage (Literature Review)

Introduction . Subretinal hemorrhage (SRH) is characterized by the accumulation of blood between the neurosensory retina and the retinal pigment epithelium and may result in sudden and severe visual loss as well as irreversible structural damage to the retina. The most common underlying causes of hemorrhage are neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Visual impairment associated with SRH is multifactorial and results from hemorrhagic detachment of the neurosensory retina in the macular region, disruption of metabolic exchange between the retina and the underlying choroid, and the toxic effects of iron released during hemoglobin degradation on the outer segments of photoreceptors. Anatomical and functional outcomes depend largely on the size, extent, thickness, and duration of the hemorrhage. With increasing duration, the toxic effects of subretinal blood become more pronounced, while progressive organization and consolidation of the blood clot make it less susceptible to fibrinolysis and mechanical displacement. Over the past several decades, surgical management of SRH has evolved considerably, ranging from direct mechanical evacuation of subretinal blood and macular translocation to fibrinolytic therapy, pneumatic displacement, and contemporary minimally invasive vitreoretinal techniques. Despite the variety of available treatment options, no universally accepted management algorithm has yet been established, and the optimal timing of surgical intervention and indications for specific surgical techniques remain a matter of debate. Purpose of the work is to review the evolution of vitreoretinal surgical approaches to the management of subretinal hemorrhage, with a focus on their clinical efficacy, limitations, complication profiles, and prospects for further refinement and development.