Submacular haemorrhage

About submacular haemorrhages

The macula is a small, but important area at the centre of the retina. It is essential for central vision and allows you to see fine details clearly.  The retina is the light sensing tissue that lines the back of your eye.

A submacular haemorrhage occurs when there is bleeding (haemorrhage) underneath the macula area.

This usually occurs in patients with age related macular degeneration (AMD), who may develop abnormal blood vessels which can bleed. If left untreated, the blood clot can damage the eye’s photoreceptors and the central vision will be permanently lost.

Other causes of a submacular bleed include trauma, inflammation or aneurysm (a bulge in the blood vessel walls).

Symptoms

Patients usually experience a sudden, painless loss and/or distortion of central vision.

Treatment

Treatment options include the following.

Injection of tPA (tissue plasminogen activator) into the eye

tPA is a protein that breaks down blood clots. We inject it into the vitreous of the eye, with the aim of breaking down the blood clot (an intravitreal injection). The vitreous is a transparent jelly-like structure that lies at the back of the eye.

Injection of a gas bubble into the eye

We often combine an injection of tPA with an injection of a gas bubble, which helps to displace the blood clot. We often perform this gas bubble injection on the same day, or one day after the tPA injection.

Surgery (vitrectomy)

We can also perform an operation called a vitrectomy [add link] to remove the blood clot. A vitrectomy removes the vitreous and this gives us access to the retina tissue, and allows us to drain or remove the blood clot.

We can perform a vitrectomy following tPA or gas bubble injection if we believe this is the best option for improving your vision.

Treatment success rates

Injections of tPA or gas successfully displace or break up the blood clot in up to 60% of eyes. This helps to improve vision once the gas bubble has absorbed.

Success rates for surgery (vitrectomy) are similar, but it is a more complex procedure.

Even if we can successfully displace (shift) the blood clot, your vision may not return to its former level, and may occasionally worsen due to underlying disease.

If your blood clot is left untreated

Studies show that the blood clot usually resolves itself in 6 to 8 months, but it often causes some scarring to the retina. This means that vision can be permanently affected, because retinal tissue scarring is not reversible.

After treatment

After your injections or surgery, we may ask you to position your head in a face down or reading position for a period of time (usually 5 days).

This can be uncomfortable, but it helps to shift the blood clot.

Everyday activities after treatment

If you have an injection into your eye, you can probably return to work the next day.

Most people need at least 2 weeks off work after surgery. This may vary depending on the kind of work you do and the type of surgery that we perform. 

Driving: this depends on the vision in your other eye. Your doctor will advise you.

Side effects and risks

Common side effects include the following.

• Red eye due to mild bruising on the surface of the eye.  This clears in 1 to 2 weeks.
• Sore and gritty eye due to disturbance to the eye surface.  This clears in 1 to 2 days.
• Floaters (blobs or lines or specks in your vision).  These usually settle in 1 to 2 weeks.

Serious but rare risks include:

• eye infection (endophthalmitis). This affects fewer than 1 in 1000 patients, but it can cause blindness [link to leaflet]
• detached retina (we can treat this with surgery) [link to leaflet]
• bleeding in the eye
• cataract (unless you have already had cataract surgery).

There is a risk of recurrence of the bleeding with both types of treatment (injection and surgery), so any treatment for age related macular degeneration may need to continue as usual.