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Displacement of Submacular Hemorrhage Using Subretinal Cocktail Injection versus Pneumatic Displacement: A Real-World
Simon K H Szeto1,2,3, Chi Wai Tsang4,5, Shaheeda Mohamed4,5
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China, simonkhszeto@cuhk.edu.hk.
Summary
Pars plana vitrectomy with subretinal cocktail injection effectively displaces submacular hemorrhage (SMH), offering better outcomes than pneumatic displacement for neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Vitreoretinal Diseases
Background:
- Submacular hemorrhage (SMH) is a significant cause of vision loss.
- Neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) are common etiologies of SMH.
- Effective surgical strategies for SMH displacement are crucial for visual recovery.
Purpose of the Study:
- To compare the efficacy of pneumatic displacement with intravitreal expansile gas versus pars plana vitrectomy (PPV) with subretinal injection of a cocktail (tPA, anti-VEGF, air) for SMH displacement.
- To evaluate visual acuity (VA) and central subfield thickness (CST) outcomes post-surgery.
- To assess complication rates and displacement success in patients with SMH.
Main Methods:
- Retrospective interventional case series of 63 patients with SMH secondary to nAMD or PCV.
- Patients underwent either pneumatic displacement or PPV with subretinal cocktail injection.
- Data collected included diagnosis, logMAR VA, CST, and postoperative outcomes up to 12 months.
Main Results:
- The subretinal cocktail injection group showed more extensive SMH, thicker baseline CST, and longer symptom-to-operation intervals.
- While both groups improved, pneumatic displacement showed significantly better VA at 12 months (0.64 vs. 1.03, p=0.040).
- Subretinal cocktail injection achieved higher rates of complete foveal displacement (87.0% vs. 37.5%) and similar safety profiles.
Conclusions:
- Surgical SMH displacement significantly improves visual acuity.
- PPV with subretinal cocktail injection is more effective for SMH displacement than pneumatic displacement, with comparable safety.
- This technique is a viable option for extensive SMH or as a rescue therapy.
