Dr. Arpitha R

Dr. RAJESH RAMANJULU, Dr. MAHESH P. SHANMUGAM, Dr. DIVYANSH MISHRA, DR. VIVEK CHAITANYA

Submacular haemorrhage of significant amount due to any cause poses threat

to vision, if left untreated. Recently established surgical method to displace

this blood includes vitrectomy followed by retinotomy with 41G needle. A

concoction of rtPA (25 µg) with 0.2cc of air/sf6 with/without anti-VEGF is

injected into the subretinal space. Air/gas being injected at last. Disadvantages

are availability of 41G needle, its cost and hazards due to malleability.

Extrusion of drug concoction can occur due to resistance.

Modification of the above technique was tested in a series of 3 patients with

comparable post operative outcome with minimal cost and spillage of drug is

presented. It involves injection of air/gas into subretinal space first, using a

26G 1.5 inch needle followed by rtPA with/without Anti VEGF. Air/gas in

subretinal space creates potential space for the drug to be delivered and

tamponades retinotomy preventing efflux of injected drug. Retinotomy with

26G needle is self sealing.