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Flynn, Jr. McCabe, MD. Abstract: The goal of the following outline is to define subretinal hemorrhage, provide differential diagnosis of its etiology, and provide a comprehensive review on the mechanistic, animal and clinical studies including case reports, retrospective case series and prospective randomized clinical trials involving management of submacular hemorrhage. Specifically, the evolution of the submacular surgery with and without tissue plasminogen activator tPA , pneumatic displacement, macular translocation, photodynamic therapy and recently use of anti-VEGF inhibitors is reviewed.

In addition, results of group B of submacular surgery trials are reviewed in detail. The document is intended to be an introduction into management of submacular hemorrhage for ophthalmology residents and vitreoretinal fellows, with an emphasis on appreciation of how developments over the years have shaped the current treatment recommendations today.

The document will be periodically updated as new studies and evidence become available. Subretinal hemorrhage is an accumulation of blood between the neurosensory retina and the retinal pigment epithelium RPE arising from the choroidal or retinal circulation. There are several pathologies that can be associated with subretinal hemorrhage, including choroidal neovascularization CNV, likely the most common cause , trauma especially in the context of choroidal rupture , and infiltrative process.