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

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.