జర్నల్ ఆఫ్ క్లినికల్ అండ్ ఎక్స్పెరిమెంటల్ ఆప్తాల్మాలజీ
అందరికి ప్రవేశం

నైరూప్య

"Managing Submacular Haemorrhage (SMH) by Pneumatic Displacement (PD) Only without Using Tissue Plasminogen Activator (tPA)"

Gitumoni Sharma, Sagarmoy Purkayastha, Deepshikha Agrawal, Hemanth Murthy and NS Muralidhar

Objective: To report results of management of submacular hemorrhage (SMH) by pneumatic displacement (PD) without use of tissue plasminogen activator (tPA).

Methods: This is a retrospective analysis from March 2007-February 2016, of patients presenting with sudden onset dimness of vision due to SMH involving the fovea. Optical coherence tomography was done. Intravitreal injection of pure perfluoropropane 0.3 ml was done under local anesthesia. Patients were instructed to maintain prone position for 7 days for 12 hours per day. After some amount of displacement occurred, funds fluorescein angiography and indocyanin green angiography were done as required to find out cause of bleed. Patients were treated as needed depending on FFA and ICG findings. The main outcome measures were clearing of haemorrhage under the macula and improvement in vision after displacement. Patients with a follow up of less than 3 months were excluded from the study.

Results: There were 15 (51.7%) males and 14 (48.27%) females of 29. Age was 52.58 ± 20.81, (range: 11-80) years. Patients presented at a mean of 12.62 days ± 14.00(range: 1-60) days. Mean Log MAR visual acuity was 1.26 (range 0.30-1.78) before gas injection and 1.17 (range 0.30-1.78), on the day of gas injection, p=0.23. Final visual acuity improved in all cases, up to Log MAR mean 0.85 (range 0.17-1.78). The improvement in visual acuity at final visit is statistically significant, p=0.0008. SMH was displaced in all cases. Follow up ranged from 90 days to 10 years (average-2.68 years).

Conclusion: Pure perfluoropropane gas (0.3) injected into the vitreous cavity can displace SMH without the use of tPA in all cases. Visual acuity after gas injection improves, making this treatment an alternative to evacuation of SMH. This also helps to find out the cause for SMH after the displacement of the haemorrhage.