Non-tPA Pneumatic Displacement of Traumatic Submacular Hemorrhage Treated by Gas-Vitrectomy: A Case Report with Multimodal Imaging Postoperative Analysis

Abstract

Our case report aimed to describe the anatomic and functional outcomes of a middle-aged male patient undergoing gas-vitrectomy for the displacement of a submacular hemorrhage and discuss the multimodal imaging postoperative findings. This chapter is developed as an elaborated version of a published paper and includes the case report of a 34-year-old man who was struck by a stone on his right eye. He was diagnosed with a traumatic submacular hemorrhage and a large paramacular retinal tear. The patient underwent a non-tPA gas-vitrectomy within three days of the accident. A multimodal evaluation, including best-corrected visual acuity, spectral-domain optical coherent tomography (SD-OCT), 10-2 and 30-2 chromatic automated central campimetry, microperimetry, and mfERG examinations, was performed six months after the accident. The multimodal imaging tests demonstrated an abnormal foveal SD-OCT pattern with a tear at the level of the retinal pigment epithelium. Campimetry demonstrated low levels of retinal sensitivity, and microperimetry and mfERG revealed a subnormal retinal response and a reduction in N1- and P1-wave amplitudes. The visual evoked potential responses were normal. Proper management of the pneumatic displacement of a significant submacular hemorrhage and the complete release of vitreoretinal traction at the tear level yielded a favorable anatomical prognosis. The multidisciplinary examination at six months revealed a structurally and functionally abnormal macula.