Gravitational displacement of SMH plausible

Gravitational displacement of submacular haemorrhage (SMH) after pars planar vitrectomy (PPV) appears to be an effective intervention, particularly in combination with subretinal tissue plasminogen activator (t-PA) and intravitreal anti-vascular endothelial growth factor (VEGF), a recent study has found.

“Displacement of submacular haemorrhage can be achieved without the use of tamponades. Not only the preretinal space but also the subretinal space is important when displacing submacular haemorrhage,” researchers said.

Researchers conducted a retrospective, interventional analysis of nine consecutive patients (mean age, 72.2 years; 55.6 percent female) with age-related macular degeneration and SMH. After the surgery, patients were positioned according to the location and distribution of SMH: three patients were instructed to sit upright, while six were asked to lie on the temporal side of the affected eye.  

Haemorrhage was almost completely displaced in all of the cases within a day after the operation. The minimal residual liquefied haemorrhages that remained were all resolved gradually over 2–3 weeks.

Moreover, following the complete displacement of SMH, residual subretinal fluid was resolved within 1 week in four patients. In the remaining five, resolution took between 2 and 4 weeks after surgery.

Patients were followed for a mean of 10.4 months, during which time two cases of SMH recurrence were documented, both occurring by month 3. Both patients subsequently underwent the same surgical procedure. There were no additional complications observed.

According to researchers, this approach has the advantage of having a short duration of application and allows for a quick evaluation of treatment response. Future comparative studies with more cases are necessary to draw stronger conclusions.