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The following is a summary of “Comparison of different treatment options in submacular haemorrhage,” published in the December 2024 issue of Ophthalmology by Hillenmayer et al.
Submacular hemorrhages (SMH) lead to substantial visual impairment, with no conclusive evidence or clear treatment guidelines on the most effective approach.
Researchers conducted a retrospective study to evaluate the effectiveness of 5 surgical treatment modalities in terms of visual prognosis and success rate.
They included 201 patients with SMH. The primary endpoint was best corrected visual acuity (BCVA), and secondary endpoints were haemorrhage size and complications. Group 1 received pneumatic displacement and rtPA-injection. Group 2 followed the “Manchester protocol” with rtPA-injection and, if necessary, pars plana vitrectomy (ppV) with subretinal rtPA while, Group 3 underwent vitrectomy with subretinal rtPA, group 4 had vitrectomy only, and group 5 received subretinal lavage.
The results showed a mean age of 79 years and a follow-up period of 4.6 months. Pre-intervention BCVA of 1.7 logMAR improved to 1.4 logMAR. A visual gain of >0.2 logMAR was observed in 47% of patients, while 20% experienced a loss of >0.2 logMAR. Statistically significant visual improvement was seen only in group 2 and group 5 had a significantly larger haemorrhage size preoperatively (P < 0.05), but all groups showed equal SMH size at follow-up. Complications led to additional interventions in 20% of patients.
Investigators concluded no significant improvement in visual prognosis was achieved with different interventions, suggesting that less invasive options may be preferable initially.
Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03794-y
