Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage

Abstract

Ismail Abdul-Salim,1 Zunaina Embong,1,2 Sonny-Teo Khairy-Shamel,1,2 Mohd-Noor Raja-Azmi,1,21Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia; 2Universiti Sains Malaysia Hospital, Jalan Raja Perempuan Zainab II, Kubang Kerian, MalaysiaAbstract: Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days’ duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive submacular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.Keywords: trauma, choroidal rupture scar, visual acuity, submacular hemorrhage, anterior uveitis