Pneumatic displacement for management of traumatic macular hole with submacular hemorrhage

Complications of closed-globe injury such as submacular hemorrhage (SMH) and traumatic macular hole (TMH) can be visually devastating. It is observed that TMH occurs in 1.4% of closed-globe injuries and 0.15% of open-globe injuries. There is limited data regarding the incidence of TMH with SMH, given its relatively rare occurrence. Treatment options for SMH include vitrectomy with subretinal r-tissue plasminogen activator (TPA)-assisted clot lysis, intravitreal r-TPA-assisted pneumatic displacement using an expansile gas and postoperative positioning, and finally pneumatic displacement alone. We report a unique case of a 26-year-old female with blunt trauma who developed SMH with TMH and breakthrough vitreous hemorrhage. Successful displacement of subretinal blood from the macula and resolution of the macular hole was achieved on day 1 with pneumatic displacement alone using undiluted C3F8 injection.