Blood in the Eye

A 40-year-old male was referred to our center from Nandyal town in Andhra Pradesh for further management. He gave a history of sudden decrease of vision following an injury to his right eye with a cricket ball. He was diagnosed to have “Blood in the eye”. On examination, he had vision of hand movements only and had vitreous hemorrhage (blood in the eyeball) as well as submacular hemorrhage (refers to blood underneath the macula which is the most sensitive central part of the retina). While blood in the vitreous cavity can be cleared relatively easily with vitrectomy surgery, clearing the blood beneath the macula is a challenge as it is relatively inaccessible and a sensitive area it would require injecting the drug directly into the submacular hemorrhage to dissolve the clot and so displace it away from the macula. These kinds of procedures are generally done for bleeding in cases of Wet Age-Related Macular Degeneration (Wet ARMD) but have not been described for cases of post-trauma etiology. After discussing the pro and cons surgery was offered to the patient. The patient underwent 25 G sutureless MIVS (Micro Incisional Vitrectomy Surgery) with subretinal injection of tPA drug (tissue plasminogen activator). Post surgery the blood clot was successfully dissolved and displaced away from the macula and the patient recovered a visual acuity of 6/36.