Clinical profile and management outcomes of traumatic submacular hemorrhage

Gaganjeet Singh Gujral; Manisha Agarwal; Rahul Mayor; Daraius Shroff; Jay Chhablani; Mahesh P Shanmugam

doi:10.1016/j.joco.2019.09.001

Clinical profile and management outcomes of traumatic submacular hemorrhage

J Curr Ophthalmol. 2019 Oct 22;31(4):411-415. doi: 10.1016/j.joco.2019.09.001. eCollection 2019 Dec.

Authors

Gaganjeet Singh Gujral¹, Manisha Agarwal¹, Rahul Mayor¹, Daraius Shroff², Jay Chhablani³, Mahesh P Shanmugam⁴

Affiliations

¹ Department of Vitreoretina, Dr Shroff's Charity Eye Hospital, Delhi, India.
² Vitreoretinal Services, Shroff Eye Center, Delhi, India.
³ Srimati Kannuri Santhamma Center for Vitreoretinal Diseases, L.V. Prasad Eye Institute, Hyderabad, India.
⁴ Department of Vitreoretinal Services and Ocular Oncology, Sankara Eye Hospital, Bengaluru, India.

Abstract

Purpose: To evaluate the anatomical and functional outcome of patients with traumatic submacular hemorrhage (SMH).

Methods: A retrospective, interventional case series of patients presenting between January 2016 and April 2018 was carried out at 4 tertiary eye care centers of India. Medical records of the patients with a history of blunt trauma and SMH were retrospectively reviewed. The intervention done was any one of the following: pneumatic displacement with 0.3 ml of intravitreal gas [100% perfluoropropane (C3F8) gas], pneumatic displacement with intravitreal 0.3 ml of 100% C3F8 gas combined with 100 μg/0.1 ml of recombinant tissue plasminogen activator (r-tpa), pars plana vitrectomy (PPV) with subretinal r-tpa and gas tamponade. The primary outcome measures included change in visual and anatomical status.

Results: Twenty eyes of 20 patients with blunt trauma were analyzed. Thirteen patients had small size SMH, 5 patients had medium size SMH, and 2 patients had massive size SMH. Sixteen patients had a favorable functional outcome, and eighteen patients had favorable anatomical outcome. The size and duration of post-traumatic SMH did not significantly affect the anatomical (P = 0.123) or functional (P = 0.293) outcome in our study. The patients who presented with initial visual acuity of 6/60 or better showed better functional outcome, which was statistically significant (P = 0.007).

Conclusion: Minimally non-invasive procedure including intravitreal r-tpa and gas appear to be effective in the displacement of post-traumatic SMH.

Keywords: C3F8; Ocular trauma; Perfluoropropane gas; Recombinant tissue plasminogen activator; Submacular hemorrhage; r-tpa.