Good Hope, Heartlands, and Solihull Eye Clinics

Submacular haemorrhage due to CNV (wet amd)

David Kinshuck

choroidal neovascularisation = CNV = wet ARMD macular haemorrhage


Occasionally large haemorrhages develop in the macular area. These are more likely in smokers, aspirin/anticoagulant users, especially if there is hypertension, or in very elderly patients. Various treatments have been tried, and the best treatment at present is gas tampanade with tissue plasminogen activator and anti-VEGF Eye 16.  another Eye 16

Injection of tissue plasminogen activator (TPA) followed by gas often displaces the blood. By displacing the blood, vision may improve, but also there will be less macular scarring and better sight in the long-term. The treatment needs to be carried out if possible within 14-21 days, and is less successful if delayed longer.

If the sight is better than 6/120 anti-vegf treatment will help AJO13. Anti-VEGFs are helpful even if given alone Eye 15.

  • Subretinal bleed irregular edge (treat with gas & tgf)

  • Subrpe very sooth edge


Causes of subretinal haemorrhage in wet armd

  • Some pcv, macroaneurysms, trauma, blood disorders, rips, large occults
  • subretinale blutungen...german paper
  • newer agents  are safer than warfarin (as warfarin may lead to an over-long prothrombin time)
  • Risk factors: Warfarin 12 times risk, aspirin x 2
  • Thickness, area and proximity to fovea are related to prognosis,
  • Usually a mixture subretinal and subrpe
  • Treat within 14 days, author says 21 days
  • Rip with haemorrhage, treat same way 
  • Pure subrpe haemorrhage would also benefit
  • Rap: single haem with exudates ..rap..bilateral,
  • Pcv: present as massive bleeds

Absolutely massive haemorrhage 

  • tpa and the day later vitrectomy 
  • 50 micrograms tpa. in 0.5 ml, 
  • Can translocate retina..wong..then later muscles

More than 300μ

  • vitrectomy etc
  • Big cnv...limits result, better with displacement though
  • Option combine with vitrectomy, with tpa lower dose, and antiVEGF 
  • Combine with avastin or luentic, NOT aflibervept,
  • use air, rapid air absorption
  • speaker prefers vitrectomy 
  • Recurrence rate 15%, so give 6m antivegf
  • Medium..position..tpa + gas + position
  • Medium can't position, vitrecotmy
  • operations 1 ml C3f8
  • 45 degrees looking down for 4 days 
  • Air absorbs 1 week, ...c3f8 4 weeks to go


Haemorrhage of less than 300μ (=550μ cft)

  • better with injections
  • antiVEGF alone

Occult ped fbv or serous
Single haem with exudates ..rap..bilateral,
Present as massive bleeds