The surgical treatment of massive submacular hemorrhages aggravating the course of exudative form of AMD with automated subretinal injection

• Main Authors: A. D. Ovchinnikova, A. V. Mironov, T. O. Dulgieru
• Format: Article
• Language: Russian
• Published: Publishing house "Ophthalmology" 2021-01-01
• Series: Офтальмохирургия
• Subjects: amd; submacular hemorrhages; vitrectomy; prourokinase
• Online Access: https://www.ophthalmosurgery.ru/jour/article/view/687

Purpose. The purpose of the study was to assess the results of the proposed method of surgical treatment of massive subretinal macular hemorrhage in the wet form of age-r elated macular degeneration.Material and methods. A comparative study of the results of treatment of massive subretinal hemorrhage associated with the exudative AMD-related. 17 patients (17 eyes) were being observed in the clinic with submacular hemorrhages of varying severity, which occurred against the background of exudative AMD-related. The average age of the subjects was 71.47±6.15 years. The maximum corrected visual acuity at the time of admission averaged 0,04±0.03. All patients were previously treated with anti-VEGF therapy, and number intravitreal injections was in the range from 3 to 14. The experience of the disease was 2,35±0,77 years, the prescription of hemorrhage – 5,47±3,55 days. The mean size of the subretinal hemorrhage was 21.41±3.37 DD. According to optical coherence tomography, the average value of retinal thickness in the macular region was 1081,29±389,67 microns. The day before surgery all patients underwent surgical treatment according to the author’s method (patent No. 2696056) – intravitreal injection Gemase® 3000 ME, 0,2 ml. The next day was performed vitrectomy 25G, local removal of the ILM and subretinal injection Gemase® 3000 ME – 0.3 ml and 0.2 ml of sterile air, fluid-air exchange 70% of the volume vitreal cavity, intravitreal injection Eylea® 0.05 ml, tamponade of vitreous cavity with 20% SF6. After the operation, the patient was placed «horizontally on the back» for 2 hours, then he had to be in an upright position to move the blood clot to the lower parts of the ocular floor .Results. Intraoperative complications were not observed in any of the cases. A complete dislocation of subretinal hemorrhage from under fovea zone was achieved in every patient’s postoperative period.Conclusion. The proposed surgical method provides rapid recovery of subject vision and can be used in the treatment of massive submacular hemorrhages of any etiology.