Acute Submacular Hemorrhage in AMD

“Submacular hemorrhage is a catastrophic event with a poor natural 

history,” said Dr. Elsbeth van Zeeburg, MD, PhD, of the Rotterdam Eye 

Hospital in The Netherlands. “There is a current trend towards vitrectomy 

with submacular administration of rtPA,” she continued, “which our study 

compared to a less invasive treatment option.”

Presenting during the EURETINA Free Paper Session on Vitreoretinal 

Surgery, Dr. van Zeeburg described the results of a single-centre, 

prospective, randomized, controlled study of treatment of this condition. 

Twenty-four patients with an acute submacular hemorrhage due to AMD 

were randomized to either intravitreal injections of rtPA, bevacizumab and 

C3F8 (“minimal invasive treatment”; n=12) or vitrectomy with subretinal 

rtPA, C3F8 gas and intravitreal bevacizumab (“maximal invasive treatment”; 

n=12). Utilizing cylindrical volume measurements on SD-OCT, the goal was 

compare dislocation of the subretinal and subRPE hemorrhage in the two 

groups. 

The study concluded that rtPA is an effective and relatively safe method 

of dislocating the submacular hemorrhage to an extrafoveal position. Total 

displacement of subretinal hemorrhage occurred in a majority of patients in 

both groups. Further, “Intravitreal injection seems as effective in displacing 

the hemorrhage as vitrectomy with submacular administration,” said Dr. van 

Zeeburg. However, total displacement of sub-RPE blood was more difficult 

to achieve, occuring in ≤20% in both groups. 

Maybe somewhat surprisingly, there were more complications following 

intravitreal administration of rtPA as compared with vitrectomy with 

subretinal injection. Nevertheless, a larger, multicenter controlled trial will 

soon compare intravitreal rtPA with anti-VEGF agents.