Submacular Haemorrhage

Causes:

  • AMD

  • PCV

  • Myopia

  • Trauma

  • Ocular histoplasmosis

  • Angioid streaks

  • Miscellanous – macroaneurysm, tumours, iatrogenic (surgical/laser), Valsalva retinopathy, DR.


Symptoms: Sudden painless loss of central vision with metamorphosia.

Investigation: OCT macula.


Prognosis factors for vision recovery:

  1. Aetiology

  2. Volume (thickness and extent)

  3. Duration (within 1-2 weeks for intervention)


Treatment options:

  1. Pneumatic displacement (100% 0.3ml C3F8) + tPA (50 micrograms/0.1ml)

  2. Anti VEGF

  3. PPV + subretinal tPA + anti VEGF + gas

  4. Macular translocation

Preparation guide for Alteplase (tPA) 50 micrograms in 0.1ml IVT injection:

  1. Use 10mg Actilyse

  2. Add 10ml water for injection (provided with Actilyse pack) to 10ml Actilyse vial –> 1mg/ml solution

  3. Shake vial to dissolve.

  4. Use 1ml syringe – draw up 0.5ml from reconstituted vial.

  5. Transfer to sterile vial.

  6. Use fresh 1ml syringe and withdraw 0.5ml water.

  7. Add the 0.5ml water into the 0.5ml reconstituted vial.

  8. Mix well –> 500 micrograms in 1ml solution.

  9. Administer 50 micrograms/0.1ml as IVT using a fresh 1ml syringe.

 
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