title: [Treatment of macular hematoma complicating AMD by vitrectomy, subretinal r-TPA injection, intravitreal injection of bevacizumab combined with gas tamponade: Report of 4 cases].
abstract: BACKGROUND
  The occurrence of a subretinal hematoma in age-related macular degeneration (AMD) is a serious complication that can impact the visual prognosis with a poor functional recovery. The management of this complication remains controversial. Several therapeutic methods have been described. We report the results of four patients treated with a protocol combining: vitrectomy, subretinal injection of r-TPA 0.025mg/0.3ml, intravitreal injection of 0.05ml of bevacizumab and retinal tamponade with 20% SF6 gas.
  
  
  METHODS
  Our series consists of four patients with a submacular hematoma complicating AMD, included in succession between October 2013 and October 2014 and treated with the same treatment protocol and by the same surgeon. All patients underwent surgery within eight days after the onset of the macular hematoma. Patients with a consultation period longer than eight days did not undergo this treatment. Face down postoperative positioning was then carried out for seven days by the patients.
  
  
  RESULTS
  We observed a shift in the macular hematoma in the four patients, which allowed the identification of secondary neovascularization responsible for the bleeding. The visual acuity improved in three patients from hand motion (HM) preoperatively to 2/10 at one month postoperatively. One patient maintained visual acuity 1/20 during the entire follow-up despite almost complete resorption of the subretinal hematoma. These visual acuities were stable at 6 months postoperatively.
  
  
  CONCLUSIONS
  Macular subretinal hematoma can cause severe visual loss by several mechanisms. The blood accumulates between the neurosensory retina and the retinal pigment epithelium, which causes a toxic effect on the surrounding tissues, thus resulting in a loss of photoreceptors and cellular destruction in the pigment epithelium and choriocapillaris, evolving into a fibroglial scar.
  
  
  CONCLUSIONS
  The therapeutic evaluation of this protocol in our series of four patients gives a favorable result. We observed an improvement in visual acuity in 3/4 of cases. This surgical technique appears to be effective in the treatment of this complication of AMD. However, a study on a larger scale is needed to confirm these results.
authors.affiliation: Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France. Electronic address: hellrider86@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Abboud
authors.affiliation: Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France.
authors.forename: M
authors.initials: M
authors.lastname: Benzerroug
authors.affiliation: Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France.
authors.forename: S
authors.initials: S
authors.lastname: Milazzo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000068258:Bevacizumab / Q000008:administration & dosage*; D005260:Female; D006406:Hematoma / Q000150:complications / Q000628:therapy*; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000150:complications / Q000628:therapy*; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage; D012166:Retinal Hemorrhage / Q000150:complications / Q000628:therapy*; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014821:Vitrectomy / Q000379:methods*
chemical_list: D011994:Recombinant Proteins; D000068258:Bevacizumab; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride
keywords: AMD; DMLA; Gas tamponade; Hématomes maculaires; Injection intravitréenne de bévacizumab; Injection sous-rétinienne r-TPA; Intravitreal bevacizumab injection; Macular hematoma; Subretinal r-TPA injection; Tamponnement par gaz