Managing massive submacular hemorrhage using intravitreal brolucizumab in combination with subretinal tissue plasminogen activator and non-expansile gas – A case report

We report a case of a 60-year-old lady presented to us with a sudden painless diminution of vision in the left eye (LE). Her best-corrected visual acuity (BCVA) was counting fingers close to face in the LE. She was diagnosed with submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV). We performed a standard 25-gauge pars plana vitrectomy with subretinal tissue plasminogen activator injection along with an intravitreal injection of brolucizumab and perfluoro propane (C3F8) gas injection. Six weeks after the procedure, her BCVA improved to counting fingers at three meters. After another two injections of brolucizumab at one-month intervals, the BCVA improved to 6/9, N6. We present the long-term follow-up of this eye for nearly 18 months with improved visual acuity, that is, 6/36, N24 at the final visit. This technique shows favorable results in the case of massive SMH due to PCV.