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SUBRETINAL ENDOSCOPIC SURGERY TO TREAT LARGE SUBRETINAL HEMORRHAGES SECONDARY TO AGE-RELATED MACULAR DEGENERATION

Kaga, Tatsushi, MD, PhD*; Kojima, Takashi, MD, PhD; Yokoyama, Sho, MD*; Sato, Hiroyuki, MD; Yoshida, Norihiko, MD§; Ichikawa, Kazuo, MD, PhD

doi: 10.1097/IAE.0000000000002031
Original Study: PDF Only

Purpose: To evaluate the potential of subretinal endoscopic surgery as a novel treatment for large subretinal hemorrhage secondary to age-related macular degeneration.

Methods: Five patients with large subretinal hemorrhage secondary to age-related macular degeneration underwent subretinal endoscopic surgery, with a minimum follow-up of 12 months.

Results: The large subretinal hemorrhage was completely removed by subretinal endoscopic surgery without a large retinotomy in all cases. The fibrovascular pigment epithelial detachment including choroidal neovascularization was completely removed in four cases. In three of these cases, the bleeding was confirmed to be originating from one point of rupture in the Bruch membrane, which was treated by coagulation using intraocular diathermy. Although visual acuity improved in three cases, it deteriorated and remained stable in one case each. Fibrovascular pigment epithelial detachment persisted in one patient after surgery; he needed anti–vascular endothelial growth factor therapy, whereas the other four did not because their fibrovascular pigment epithelial detachment was removed. At the final follow-up, no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy, were noted.

Conclusion: Subretinal endoscopic surgery can completely remove subretinal hemorrhage and fibrovascular pigment epithelial detachment including choroidal neovascularization without a large retinotomy. It also aids in the direct and detailed confirmation of subretinal lesions by ophthalmic endoscope.

This study describes a novel subretinal endoscopic surgery technique for treating large subretinal hemorrhages secondary to age-related macular degeneration. This procedure neither requires a large retinotomy and nor does it result in severe postoperative complications such as retinal detachment or proliferative vitreoretinopathy.

*Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan;

Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan;

Satoh Yuya Eye Clinic, Sendai, Japan;

§Department of Ophthalmology, Japanese Red Cross Gifu Hospital, Gifu, Japan; and

Chukyo Eye Clinic, Nagoya, Japan.

Reprint requests: Tatsushi Kaga, MD, PhD, Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjo Minami-ku, Nagoya-city, Aichi Prefecture 457-8510, Japan; e-mail: kaga@chukyogroup.jp

Paper presented at Japanese Retina and Vitreous Society, Nagoya, Japan, December 2, 2016.

None of the authors has any financial/conflicting interests to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com).

© 2018 by Ophthalmic Communications Society, Inc.