The surgical treatment of massive submacular haemorrhage in patient with neovascular age-related macular degeneration (clinical case report)

Author: Victoria Rudenko (Russian Federation)

Co-authors: Alexandr Khudiakov, Oleg Kolenko

Purpose

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years old. About 10% of patients with AMD have the neovascular form. Complicated forms of AMD in 15% of cases lead to deep and permanent visual loss, one of the main causes of which is submacular hemorrhage (SMH). The presence of hemosiderin in the blood has toxic effects on the overlying photoreceptors; clot retraction can damage the photoreceptors. Early intervention is generally better. Purpose – the analysis of surgical treatment of massive SMH by subretinal injection of recombinant prourokinase in patient with neovascular AMD.

Setting/Venue

The work was performed in the S. Fyodorov Eye Microsurgery Federal State Institution, Khabarovsk, Russia

Methods

Women, 56 years old with massive SMH associated with neovascular AMD was observed. The period of manifestation of SMH was 5 days. Best corrected visual acuity (BCVA) was 0,05. There was no previous anti-VEGF treatment. During fundus examination massive subretinal haemorrhage in macular area was revealed. The central macular thickness (CMT) was 1025 μm. Patient underwent 25Ga pars plana vitrectomy. Then subretinal injection of recombinant prourokinase 2000 IU was performed by using small 38Ga microcannula. Finally, fluid-air exchange with postoperative vertical head positioning was performed. SMH was displaced thus from the macular area to the inferior periphery.

Results

No complications during the surgery were noted. There was attached retina in macular area in 7 days after surgery. BCVA increased to 0,3. CMT decreased to 307μm. The follow up period was 30 months. During advanced follow up period the BCVA increased to 0,5. There was full reduction of SMH. The retina was attached. Patient noted the improvement of BCVA and disappearance of spot in central visual field. There were no recurrent SMH and macular edema in follow up period.

Conlusions

1. The analysis of long-term outcomes of surgical treatment of massive SMH by subretinal injection of recombinant prourokinase in patient with neovascular AMD revealed high efficacy of this method. 2. This method of surgical treatment may increase and save visual acuity in such patients and significantly reduce the size of central scotoma.