[Fresh submacular hemorrhage--results of surgical removal by pars plana approach]

The natural course of prominent central subretinal hemorrhages may lead to central scotomas with loss of central visual function due to toxic and mechanic damage to the photoreceptor cells. We report results after operative removal of acute submacular hemorrhages in five patients.

In five patients with central subretinal hemorrhage we removed the subretinal bloodclot by means of endosurgery through pars plana and retinotomy. As internal tamponade we used SF6 gas/air mixture (4 patients) and silikon oil (1 patient). The cause of the subretinal hemorrhage was disciform senile maculadegeneration in 4 patients and rupture of an arterial macroaneurysm in one patient. The postoperative course was free of complications in four patients. One patient developed retinal detachment, the retina could be reattached by episcleral buckling procedure.

Out of the four patients with disciform maculadegeneration three had an improvement of visual acuity of more than two lines postoperatively. In one patient the visual acuity showed only a minimal improvement. There was no decrease of visual acuity in any patient. There was a marked improvement of vision in the patient without preexisting maculadegeneration, whose bleeding was caused by a ruptured arterial macroaneurysm. Two out of five patients developed in due course a proliferative vitreoretinopathy. Visual acuity was not decreased by proliferative vitreo-retinopathy and until now there has been no indication for surgical intervention.

Indications for surgical removal of central subretinal bleedings are in our opinion that the hemorrhage must be prominent and include the macula, that the hemorrhage is not older than one week and that visual acuity was better before hemorrhage. After careful consideration the surgical extraction of central subretinal bleeding via pars plana and retinotomy can be recommended and may be useful in some patients.