A patient presented with enlarging central scotoma in his left eye for 2 days prior. He has a history of wet AMD in his right eye that is under active anti-VEGF therapy. Diagnosis was new conversion to wet AMD in his left eye with new onset massive submacular hemorrhage. Vision was 20/30-2 OD, CF @ 1FT OS. Given the recent onset of massive SMH in an AMD patient, RPE tear was suspected, and OCTA confirmed the diagnosis. While no consensus exists on optimal treatment algorithm, large and thick submacular hemorrhage of recent onset and good prior visual acuity may be the best candidates for surgery. In the end, the patient underwent pars plana vitrectomy with subretinal tissue plasminogen activator (tPA) injection and gas displacement with SF6. Patient also received aflibercept as continued medical treatment. On follow up, vision improved to 20/70+1. The main factors limiting visual outcome was subfoveal MNV and the formation of RPE tear.
Presentation Date: 04/14/2022
Issue Date: 04/29/2022