Título / Title

INTRAVITREAL GAS AND ANTI-VEGF INJECTION FOR THE TREATMENT OF SUBFOVEAL HEMORRHAGE AFTER BLUSH EYE TRAUMA – CASE REPORT

Introdução / Purpose

To report the evolution of a case of subfoveal hemorrhage due to trauma after combined treatment with intravitreal injection (IVI) of gas and antiangiogenic.

Material e Método / Methods

Interventional case report

Resultados / Results

Male patient, 12 years old, presented to the service with a complaint of low visual acuity (VA) in the right eye (OD) after blunt trauma with coconut a few hours ago. At ophthalmologic examination, OD had VA of counting fingers at 2 meters and intraocular pressure (IOP) of 6 mmHg. Retinal mapping showed OD with a normal colored optic disc, vasculature unremarkable, subretinal hemorrhage in the posterior pole with suspected areas of choroidal rupture, retina applied with commotio retinae in the periphery at almost 360º. Optical coherence tomography (OCT) of the OD macula showed a foveal thickness of 421μm associated with the presence of subretinal fluid of heterogeneous reflectivity. The patient underwent IIV of 0.3ml 100% C3F8 gas and 0.05ml Ranibizumab (RBZ) in OD. On the fifth POD, he had uncorrected VA 20/300 and IOP 10 mmHg. Fundoscopy showed a clean vitreous with a superior gas bubble, a hemorrhage-free macula with a wedge-shaped lesion suggestive of choroidal rupture and wrinkling of the internal limiting membrane, applied retina with improvement in the appearance of the commotio retinae area. On the 42nd POD, the patient had an uncorrected VA of 20/20 and an IOP of 13 mmHg. Fundoscopy showed clean vitreous, temporal fibrotic lesion inferior to the fovea, scar line in papillo-macular bundle, fovea apparently without thickening, and without lesions. The patient had a good evolution in the 1-year follow-up, with a VA of 20/20.

Discussão e Conclusões / Conclusion

Intravitreal injection of RBZ and C3F8 gas, together with the prone position, may be a valuable therapeutic option in eyes with post-traumatic subfoveal hemorrhage, in order to displace blood from the foveal area and, thereby, reduce its toxicity to the photoreceptors.

Palavras Chave

Subfoveal hemorrhage, intravitreal injection

Area

CLINICAL RETINA