From the Guidelines
The treatment of retinal hemorrhage should prioritize anti-VEGF injections, such as bevacizumab, ranibizumab, or aflibercept, administered intravitreally every 4-6 weeks initially, as they have been shown to be effective in treating macular edema associated with retinal vein occlusions 1.
Treatment Approach
The approach to treating retinal hemorrhage depends on its underlying cause, location, and severity. For mild retinal hemorrhages, especially those caused by conditions like diabetic retinopathy or hypertension, the primary approach is to manage the underlying condition. This includes:
- Controlling blood pressure with medications like ACE inhibitors (e.g., lisinopril 10-40mg daily) or ARBs (e.g., losartan 25-100mg daily)
- Optimizing blood glucose levels in diabetic patients through insulin therapy or oral hypoglycemics
Vascular Abnormalities
For hemorrhages caused by vascular abnormalities, treatments may include:
- Laser photocoagulation to seal leaking blood vessels
- Anti-VEGF injections, such as bevacizumab (Avastin, 1.25mg), ranibizumab (Lucentis, 0.5mg), or aflibercept (Eylea, 2mg) administered intravitreally every 4-6 weeks initially
Severe Hemorrhages
Severe hemorrhages, particularly those affecting the vitreous or causing retinal detachment, may require:
- Vitrectomy surgery to remove blood and repair damaged tissue
Follow-up
Regular follow-up with an ophthalmologist is essential, typically every 1-3 months initially, with frequency adjusted based on clinical response. Early treatment is crucial as retinal hemorrhages can lead to permanent vision loss if the underlying cause isn't addressed promptly 1.
Systemic Evaluation
The extent of the systemic evaluation is dependent on the patient’s age and medical history, and discussion with the primary care doctor is important, since a patient who has had an RVO is at risk for developing an RVO in the fellow eye and has a higher risk of cardiovascular disease and cerebrovascular accidents 1.
From the Research
Retina Hemorrhage Treatment
- The treatment of retina hemorrhage depends on the underlying cause, with options including laser photocoagulation, vitrectomy surgery, and intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents 2, 3, 4.
- For diabetic retinopathy, intravitreal anti-VEGF therapy has been shown to be effective in improving visual acuity and reducing the severity of the disease 3, 5.
- Bevacizumab and ranibizumab are two commonly used anti-VEGF agents, with studies suggesting that they have similar efficacy in treating retinal vein occlusion 6 and diabetic macular edema 5.
- However, the efficacy of these agents may vary depending on the underlying cause of the retina hemorrhage and the individual patient's characteristics 4, 5.
- Other treatment options, such as intravitreal tissue plasminogen activator (tPA) and pneumatic displacement, may also be effective in treating submacular hemorrhage 4.
- The choice of treatment should be based on a comprehensive evaluation of the patient's condition and the underlying cause of the retina hemorrhage 4, 5.
Treatment Options
- Laser photocoagulation: used to treat proliferative diabetic retinopathy and retinal breaks 2.
- Vitrectomy surgery: used to remove blood and scar tissue from the eye 2, 4.
- Intravitreal injections of anti-VEGF agents: used to treat diabetic retinopathy and retinal vein occlusion 3, 6, 5.
- Intravitreal tissue plasminogen activator (tPA) and pneumatic displacement: used to treat submacular hemorrhage 4.
Efficacy of Treatment Options
- Intravitreal anti-VEGF therapy: has been shown to be effective in improving visual acuity and reducing the severity of diabetic retinopathy 3, 5.
- Bevacizumab and ranibizumab: have similar efficacy in treating retinal vein occlusion 6 and diabetic macular edema 5.
- Vitrectomy surgery: can be effective in removing blood and scar tissue from the eye, but may have a higher risk of complications 2, 4.