Two retrospective case reports are described showing the efficacy of pneumatic displacement with 40-degree downward gaze positioning for treatment of submacular
hemorrhage. Case 1 involved an 85-year-old woman who visited our clinic with a complaint of blurred vision in her right eye. Best corrected visual acuity (BCVA) of the right eye was hand motion. Her right eye showed a submacular
hemorrhage with
retinal macroaneurysm. Prone positioning was difficult because of the patient's age and
obesity. The treatment method was pneumatic displacement with 40-degree downward gaze positioning after
intravitreal injection of 100%
sulfur hexafluoride gas. After the treatment, the
hemorrhage moved downward and BCVA of her right eye was 0.1. Case 2 involved a 58-year-old man with a complaint of blurred vision in his left eye. BCVA of his left eye was 0.3 and submacular
hemorrhage was observed. He underwent displacement of the
hemorrhage as previously described.
After treatment, the submacular
hemorrhage moved downward. Angiography detected a polypoidal lesion with a vascular network. upon diagnosis of
polypoidal choroidal vasculopathy,
bevacizumab was injected intravitreally. Two months after gas injection, the submacular
hemorrhage disappeared. Optical coherence tomography showed flattening of the submacular retinal pigment epithelium, which was not observed prior to
bevacizumab therapy. BCVA of the patient's left eye was 0.9. Pneumatic displacement with 40-degree downward gaze positioning after intravitreal
sulfur hexafluoride injection is useful to displace a submacular
hemorrhage. Early application of this treatment provides improvement of vision and facilitates fundus examination, which could reveal the cause of the submacular
hemorrhage.