[Subretinal surgery for massive hemorrhage]. / Subretinale Chirurgie bei Massenblutung.

ABSTRACT

Subretinal massive hemorrhage due to exsudative age-related macular degeneration remains a challenging field for submacular surgery. While small hemorrhages can be easily displaced by various pneumatic techniques the correct strategy for massive subretinal bleeding is still under debate. This article reviews the different techniques for these severe cases and assesses the visual prognosis and potential complications. In general, invasive techniques for extraction of the neovascular membrane with or without macular translocation or retinal pigment epithelium (RPE) choroidal patch translocation have the potential to achieve visual improvement. However, the risk of severe visual loss due to subsequent complications has to be considered. Far better visual results with a significantly lower complication rate can be achieved by a 2-step strategy using rTPA-assisted dissolution of the hemorrhage and evacuation of the liquefied clot via a small retinotomy.