Large submacular hemorrhage following PDT with verteporfin in patients with occult CNVM secondary to age-related macular degeneration

Subretinal recombinant tissue plasminogen activator and pneumatic displacement for the management of subretinal hemorrhage occurring after anti-VEGF injections for wet AMD

We describe three cases of submacular hemorrhage that occurred two to four days after anti-VEGF intravitreal injection for occult choroidal neovascularisation in age-related macular degeneration and their management with 25 gauge pars plana vitrectomy with injection of subretinal recombinant tissue plasminogen activator (rTPA) followed by fluid-air exchange and postoperative prone position. Vitrectomy, subretinal rTPA injection and fluid-gas exchange apply as a safe and effective treatment in these cases. Functional results seem to be positive especially if surgical treatment is promptly performed.

[Massive hemorrhage following photodynamic therapy in exudative ARMD]

Photodynamic therapy (PDT) can prevent visual loss and the risk of hemorrhage in exudative ARMD. Nevertheless, it can sometimes complicate with massive hemorrhage. We report the case of a massive macular hemorrhage 4 days after a first treatment with dynamic phototherapy (PDT) with Visudyne for rapidly progressive (6 months) exudative AMD with occult neovessels in an 86-year-old female. The rationale for PDT was a rapidly progressive lesion with preserved visual acuity (20/40). Four days after injection, a massive submacular hemorrhage of 6 disc diameter developed, with a dramatic decrease in visual acuity. This hemorrhage recovered within 6 months, producing large, fibroglial, submacular scarring with changes on the retinal pigment epithelium. This case highlights the possible side effects of this treatment.