[The clinical significance and management of submacular hemorrhage]

In submacular hemorrhage, blood accumulates in the macular area between the neuroretina and the retinal pigment epithelium. This ophthalmic condition can lead to potentially serious vision impairment and decline in the quality of life. Alarming symptom is a sudden, fixed, grayish-black scotoma appearing in the patient's central visual field, indicating macular involvement. It can be caused by various eye diseases, most commonly by choroidal neovascularization, especially in wet age-related macular degeneration. However, the course of the disease can be significantly influenced by systemic diseases (e.g., hypertension) and medications (e.g., antithrombotic drugs). The timing of adequate treatment plays an important role in its management, which is substantially supported by the advanced multimodal imaging. Although there is still no uniform treatment protocol, the Manchester Protocol can serve as a guideline for the treatment in the arsenal of available conservative and surgical solutions. If the criteria of the study (submacular hemorrhage exceeding the extent of 2 optic discs and occurring within 2 weeks without vitreous hemorrhage) are met, triple therapy: intravitreal injection of recombinant tissue plasminogen activator, vascular endothelial growth factor inhibitor and gas tamponade can be used effectively and safely in the treatment of submacular hemorrhage caused by choroidal neovascularization. Surgical procedure may be necessary in the case of contraindication or failure of the triple therapy. The aim of our summary statement is to emphasize the importance of holistic approach, early and step-by-step intervention in the management of submacular hemorrhage. Orv Hetil. 2026; 167(24): 943-951.