Most choroidal hemorrhage cases can be managed by pharmaceutical therapy, surgeon says

PUNTA DEL ESTE, Uruguay — Selected cases of choroidal hemorrhage may require surgery, but one surgeon said here that most cases can be managed through pharmaceutical treatment.

"The question today is: Is there a role for surgical intervention? The short answer is yes, but in very, very selected cases and size matters," Nauman Chaudhry, MD, said at Subspecialty Day of the Curso Regional Panamericano. "Most of the hemorrhages you see can be managed through medicals."

Uncomplicated small and moderate hemorrhages can be treated through tissue plasminogen activator with pneumatic displacement or intravitreal injections of anti-VEGF, he said, but larger hemorrhages still require surgery.

Dr. Chaudhry said anti-VEGF agents such as Avastin (bevacizumab, Genentech) are a possible nonsurgical option. In addition, he said his criteria for the in-office pneumatic displacement procedure is recent moderate submacular hemorrhage, a thick layer under the fovea, absence of thick sub-RPE blood and useful vision before the procedure.

In a small study of 11 patients who received intravitreal tissue plasminogen activator with pneumatic displacement, 100% improved, he said.