First Author: S.Astir INDIA
Co Author(s): C. Shroff C. Gupta D. Shroff G. Bhatia N. Atri
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To highlight the vagaries in management of subretinal haemorrhage in a young lady.
Shroff Eye Centre, New Delhi - Tertiary care retina service
A female aged 39 years came in with sudden drop in visual acuity: Counting Fingers-3M in Left eye since 1 week. Fundus examination revealed large sub-retinal haemorrhage involving macula. She had received Progesterone injection a week beforehand, following which she developed severe vomiting. No history of Trauma, Diabetes, Hypertension, Hypercoagulopathy, Anticoagulants. She underwent Intra-vitreal injection of Tissue Plasminogen Activator, C3F8 and Ranibizumab injection which displaced sub-retinal Haemorrhage inferiorly. ICG-Angiography showed a round hyperfluorescent-lesion superior to fovea suspicious of a polyp. A week later, her vision dropped to hand movements close to face due to breakthrough vitreous haemorrhage, for which she underwent vitrectomy.
The video depicts an animation of the displacement of haemorrhage, multimodal imaging post-displacement and the vitreoretinal surgical procedure. Intraoperatively, after clearing the vitreous haemorrhage, difficulty in detecting and removing posterior hyaloid because of vitreoschisis is illustrated. Intraoperative indirect opthalmoscopy with scleral indentation revealed a gush of sub-retinal altered blood into the vitreous cavity from a specific point in the inferotemporal quadrant, whenever the scleral indentation passed over that area. Subsequently under high magnification of the operating microscope, a retinal break was detected over the sub-retinal haemorrhage mound. Per-fluoro-carbon-liquid was injected followed by fluid-air exchange, endolaser and silicone oil injection
The video depicts a stepwise approach and the difficulties encountered in the surgical management of a subretinal bleed of obscure aetiology in a young lady. It also emphasises the importance of a thorough examination of the retinal periphery during vitreoretinal surgery