Submacular Hemorrhage Secondary to nAMD

  

Submacular hemorrhage (SMH) is an accumulation of blood between the neurosensory retina and the RPE, which can have devastating visual outcomes. They are commonly seen in patients with neovascular age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), retinal arterial macroaneurysms (RAM), pathologic myopia, and other less common etiologies like traumatic choroidal rupture, pseudoxanthoma elasticum, and iatrogenic causes. This case highlights an ambulatory, independent patient with significant vision loss from a SMH who was treated with pars plana vitrectomy (PPV), submacular tissue plasminogen activator (tPA) administration, and pneumatic displacement of the hemorrhage and had almost complete visual recovery to his baseline visual acuity. Management strategies for SMH include medical treatment with intravitreal injections or surgical treatment with many described techniques. The available literature has shown no significant difference in visual outcomes between medical and surgical management; however, the comparison is riddled with variables that are difficult to compare, pointing to the fact that there may be a role for each modality and case selection may be important. Further research is needed to determine which patients would benefit most from each modality.

Presentation Date: 10/03/2024

Issue Date: 11/26/2024