Novel Surgical Approach to Submacular Hemorrhage in the Setting of Extensive Pan-retinal Photocoagulation

Purpose: To describe a novel surgical approach for managing submacular hemorrhage (SMH) in the setting of extensive panretinal photocoagulation (PRP) where conventional displacement techniques are limited by chorioretinal adhesions. Methods: We report the case of a 73-year-old monocular woman with neovascular age-related macular degeneration (AMD) and dense PRP scars who presented with an acute, fovea-involving SMH. A modified pars plana vitrectomy (PPV) was performed using submacular tissue plasminogen activator (tPA), perfluorocarbon liquid (PFCL) tamponade to direct blood toward three small retinotomies, active aspiration, and silicone oil placement. Results: This strategy achieved substantial clot evacuation and anatomic resolution. The patient’s final visual acuity improved to 20/200. Conclusion: Multiple small retinotomies with PFCL-assisted drainage may serve as a viable alternative surgical technique for SMH in eyes with extensive PRP scarring, where retinal adhesions preclude conventional displacement methods.