Rapid displacement of subretinal hemorrhage from a choroidal neovascular membrane with intravitreal C3F8 gas and face-down positioning

Abstract

Purpose: To describe a case of rapid displacement of subretinal hemorrhage (SRH) from a choroidal neovascular membrane (CNV) with intravitreal injection of C3F8 gas. Observations: A 66-year-old patient presented in clinic with count fingers (CF) vision from a fibrovascular scar in the right eye (OD) and 20/30 vision in the left eye (OS) with butterfly dystrophy. His left eye developed a CNV and was managed with monthly intravitreal anti-VEGF agents for 29 months. Five days after a ranibizumab treatment, the patient developed a moderate subfoveal hemorrhage. The vision decreased from 20/30 to 20/50. He elected to monitor the disease process. Eleven days later the vision decreased to 20/200, and he consented to intravitreal injection of 0.3 cc of 100% C3F8 with face-down positioning. The patient received an anterior chamber paracentesis to manage the intraocular pressure. The patient had near complete displacement of subretinal hemorrhage and fluid in less than 2 hours. He then had repeat OCT and fundus photos to document the rapid displacement. His vision returned to 20/30-2 twelve days later, at which point the subretinal fluid and blood had been completely displaced from the macula. Conclusions and Importance: The patient had rapid displacement of subretinal hemorrhage and fluid with intravitreal C3F8. New blood filling the space of pre-existing neurosensory fluid from the active CNV likely enhanced displacement. Timely intervention before stable clot formation was helpful for ease of displacement of the subretinal hemorrhage. Keywords: Choroidal neovascularization, Subretinal hemorrhage, Intravitreal C3F8 gas pneumatic displacement, Neovascular age-related macular degeneration