Question 1

What causes a sub-macular bleed?

Accepted Answer

The most common cause is macular degeneration. In more advanced stages of macular degeneration, there is growth of abnormal blood vessels which can leak and bleed.

Question 2

Is it dangerous or sight-threatening?

Accepted Answer

Yes, blood under the retina is toxic and if not removed, can cause permanent damage and scarring to your retina.

Question 3

How is it treated?

Accepted Answer

The aim of treatment is to reduce the amount of blood in the subretinal space. 
There are a few options that have been used by various retinal surgeons throughout the world. These can be used in alone or in combination with each other.

A. Injection of alteplase into the eye, which breaks down blood clots. This can injected in the cavity of the eye (vitreous) OR into the subretinal space where the blood has accummulated. 
B. Injection of an expansile gas bubble into the eye to push blood away from the central retina
C. Injection of an Anti-VEGF into the eye (a medication that shrinks the leaky blood vessels to prevent recurrence). 
D. Surgery (Vitrectomy). This is the most definitive procedure, where we use microincisions to go inside the eye, remove any blood in the eye cavity, and perform A, B and C mentioned above. 
My preference and training is to perform D (if your eye is suitable) as it makes sense to maximally remove as much blood as possible from the subretinal space.

Question 4

How effective is treatment? Will I be able to see again?

Accepted Answer

A submacular haemorrhage is a serious condition which needs to be managed urgently. If the blood is left for more than 2 weeks, any intervention is unlikely to help much. 
All the procedures above have had documented success in improving vision. Unfortunately however, it is unlikely that your vision will ever go back to normal. 
If you are an appropriate candidate for surgery, it may provide the best outcome as treatment is more targeted and precise. However, any surgery carries risks and thus I will discuss the pros and cons with you in detail, including answering any questions you or your family may have.

Question 5

What can I expect if I undergo surgery?

Accepted Answer

Surgery is usually done under local anaesthetic with some mild sedation i.e. anaesthesia is used to numb the eye whilst some relaxing medication is given via a drip. 
All you have to do is lie still on your back, listen to the relaxing music being played whilst the surgery is performed. This takes approximately 45 minutes. 
After surgery, a pad is used to cover your eye, and you are then discharged home. We will also give you instructions on how to position after surgery - which is usually to lie flat on your back for 2 hours, followed by sitting upright/sleeping on 3 pillows for the next 3 days.

Question 6

What is the aftercare AFTER surgery?

Accepted Answer

I usually see my patients the next day after surgery, and commence eye drops (an antibiotic, a steroid and a dilating drop).
The next appointment will typically be a week after. 
Depending on the cause of the bleed, you may also require regular eye injections after the initial treatment to maximise healing and to also prevent a recurrence in the future.

Submacular bleed / haemorrhage