First Author: C.Lee UK
Co Author(s): L. Makris A. Kamal
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To report the anatomic and functional outcome in patient with severe visual loss after acute massive sub-ILM haemorrhage treating with intravitreal injection of sulphur hexafluoride (SF6) gas and head down posturing.
University of Aintree (UHA) – Retinal department in a tertiary referral centre in Liverpool UK.
Clinical details recorded before any treatment with documentation of Fluorescein Angiography (FFA) and spectral domain optical coherence tomography (SD-OCT) at each visit following the procedure include LogMAR Best Correct Visual Acuity (BCVA), Intraocular Pressure (IOP), cataract progression requiring surgery, SD-OCT and any complications.
A 78 year old female presented with a decrease in central visual acuity in the right eye lasting for two weeks. Best corrected visual acuity (BCVA) at baseline was counting fingers in the right eye and 6/6 in the left eye. Following investigations, a retinal arterial macroaneurysm (RAMA) superior to the macula was identified with a large sub-ILM haemorrhage in the macular area, measuring 4344 µm in diameter (central macular thickness (CMT) wad 596 µm). Treatment was initiated with intravitreal injection sulphur hexafluoride (SF6) gas with head posture down 50 minutes per hour for 3-4 days. The RAMA was treated with argon laser (pascal). Four weeks following this procedure, the patients BCVA improved to 6/36, imaging demonstrated that the central sub-ILM haemorrhage had reduced in size, diameter being 2718 µm and CMT 401 µm. The patient was re-listed for another SF6 injection. Four weeks after this treatment, BCVA in the right eye was 6/6, imaging showed that the Sub-ILM haemorrhage had displaced inferiorly and retracted (CMT was 326 µm and diameter was 1305 µm). Patient was delighted with this outcome. Both IOP and anterior segment remained normal throughout.
We report excellent visual and anatomical outcomes following treatment of sub-ILM haemorrhage due to a RAMA with intravitreal injection of SF6 gas and head down posturing. Further clinical studies should examine this technique in order to establish its place within the current remit of therapeutic options.