Abstract Submacular haemorrhage (SMH) is a sight-threatening retinal emergency characterised by the accumulation of blood between the neurosensory retina and the retinal pigment epithelium. Iron toxicity, mechanical shearing of photoreceptors, and metabolic blockade of nutrient exchange all cause central vision loss that happens quickly and is often permanent. The most common causes are neovascular age-related macular degeneration (nAMD), polypoidal choroidal vasculopathy (PCV), trauma, and retinal arterial macroaneurysm (RAM). The prognosis is contingent upon the volume, thickness, duration, and aetiology of the haemorrhage, with timely intervention being essential for visual recovery. Management seeks to displace or liquefy the clot, clear the subfoveal space, and address the underlying pathology. Anti-VEGF monotherapy is effective for small, thin, CNVM-related haemorrhages and is still the main treatment. For medium-sized haemorrhages, a combination of anti-VEGF therapy with pneumatic displacement or pars plana vitrectomy using subretinal tissue plasminogen activator (tPA) is helpful. Massive haemorrhages have a poor visual prognosis regardless of intervention and are often managed conservatively. Recent evidence advocates for personalised therapy tailored to the extent, chronicity, and aetiology of haemorrhage, with early intervention within 2 weeks yielding optimal outcomes. This review examines the classification, mechanisms of retinal injury, prognostic factors, and current therapeutic options for submacular haemorrhage (SMH), highlighting the necessity of prompt, individualised, and evidence-based management strategies to enhance visual outcomes and avert irreversible macular damage.
Acharya et al. (Thu,) studied this question.