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Massive Sub-retinal Hemorrhage, a Challenge for Vitreo-retinal Surgeons with Limited Functional Success
Schmidt J. C., Meyer C. H.,
Philipps-Universität Marburg, Medizinisches Zentrum für Augenheilkunde (Marburg)
Purpose: Patients with progressed age-related macular degeneration (AMD) and massive subretinal hemorrhage may experience severe loss of peripheral vision, leading to a significant reduced life quality.
Methods: During the years 1995- 2001 we operated 5 eyes (5 patients) with acute massive subretinal hemorrhage extending all four quadrants and severe reduced vision in the fellow eye due to Kuhnt-Junjus-scar. Within an interval of 1-2 weeks after the bleeding a pars-plana vitrectomy with a peripheral retinotomy was performed. After the retinal was put up side down and the partially liquefied blood was removed and the underlying subfoveal CNV- membrane was removed with a vitrectome. Three phacic eyes required an additional cataract surgery and IOL-Implantation. The retina reattached under PFCL and a SI-ole tamponade for 3-6 months.
Results: The removal of the subretinal hemorrhage was without severe complications. The size of the subretinal membrane was between 4-6 PD with partially fibrovascular tissue. After the membrane was removed a large central pigment epithelial defect made a macular rotation feasible. Visual acuity improved from preoperatively LS+ -Hbw+ to postoperatively 1/35- 0,1 after a follow-up of 3- 6 months. Silicone ole removal was performed 5-9 months after surgery.
Conclusions: Patients with acute vision loss due to massive subretinal hemorrhages may benefit from subretinal surgery with removal of the subretinal blood and achieve better vision for their orientation. The functional results are limited by an extended central defect of the RPE, which usually also excludes macular translocation.