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Submacular hemorrhage management
Author(s) -
Pournaras C.
Publication year - 2017
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2017.03315
Subject(s) - medicine , complication , macular degeneration , choroidal neovascularization , toxicity , neovascularization , ranibizumab , surgery , ophthalmology , bevacizumab , angiogenesis , chemotherapy
Summary Submacular haemorrhage ( SMH ) is a sight threatening complication that can occur in exudative age related macular degeneration ( AMD ). Left untreated, SMH carries a grave visual prognosis. Diagnosis and effective management of this complication are important. The treatment strategies for SMH include displacement of blood from the fovea, usually by injection of an expansile gas, pharmacologic clot lysis such as with recombinant tissue plasminogen activator (rt PA ) and treatment of the underlying choroidal neovascularization ( CNV ), such as with antivascular endothelial growth factor (anti‐ VEGF ) agents. These three strategies have been employed in isolation or in combination, some concurrently and others in stages. In cases presenting early, pneumatic displacement alone with anti‐ VEGF may be sufficient. rt PA has demonstrable effect on the liquefaction of submacular clots but there are remaining uncertainties with regards to the dose, safety and the timing of initial treatment. Potential side effects of rt PA include pigment epithelial toxicity, increased risk of vitreous haemorrhage and systemic toxicity. Anti‐ VEGF monotherapy is a treatment option particularly in patients with thinner SMH and those who are unable to posture.