Minimally invasive surgical treatment for organized submacular hemorrhage

    Abstract

    Minimally invasive surgical treatment for organized submacular hemorrhage

    E.D. Bosov, R.R. Fayzrakhmanov, V.A. Bogdanova, E.E. Vaganova

    N.I. Pirogov National Medical Surgical Center, Moscow, Russian Federation

    Purpose. To present a method of minimally invasive surgery, including two-port 27G surgery with controlled administration of a solution of recombinant prourokinase in a patient with organized submacular hemorrhage (SMH).

    Material and methods. A patient with SMC lasting 30 days underwent a procedure developed on the basis of the Center for Ophthalmology «N.M. N.I. Pirogov» is a minimally invasive technique that includes a two-port 27G access without vitreectomy with controlled administration of a solution of recombinant prourokinase 500 ME through a 38G cannula subretinally, followed by tamponade of the vitreal cavity with a 20% gas-air mixture of hexafluoroethane C2F6. A standard ophthalmological examination was performed before the start of treatment, on the 1st day, 2 weeks later, 6 months after vitreoretinal intervention.

    Results. Visual acuity was 0.1 at the initial examination and 0.05 upon admission to the surgical hospital. Follow-up showed an increase in visual function to 0.3 at 1 month and to 0.5 at 6 months with antivasoproliferative therapy. According to optical coherence tomography at the initial examination, the central retinal thickness (CRT) was 642 µm, followed by a depression of up to 451 µm by the time of hospitalization. On the 14th day, the decrease in CRT reached 267 µm with complete translocation of the hemorrhage and 243 µm after 6 months. The height of detachment of the retinal pigment epithelium at the initial examination showed a value of 167 µm, and at subsequent observation it was 45 µm, 38 µm and 12 µm on the 1st, 14th day and after 6 months, respectively. Against the background of anatomical results, there was a decrease in the zone of absolute scotoma from 25 loci at the time of admission to 3 loci after 6 months, and an increase in total photosensitivity from 4.5 dB to 15.6 dB, respectively.

    Conclusion. The use of a minimally invasive method for the treatment of SMH, including subretinal administration of tissue plasminogen activator without vitreectomy with gas-air tamponade, improves morphological and functional prognosis. However, further study of the proposed technique on long-term hemorrhages is required.

    Key words: submacular hemorrhage, tissue plasminogen activator, pneumodislocation

    For citation: Bosov E.D., Fayzrakhmanov R.R., Bogdanova V.A., Vaganova E.E. Minimally invasive surgical treatment for organized submacular hemorrhage. Clinical cases in ophthalmology. 2023;1: 30–34.

    Corresponding author: Eduard D. Bosov, bosov007@gmail.com