El Mollayess G, Jaroudi M, Tlaiss Y, Itaoui R, Abiad B. Surgical management of acute choroidal neovascularization related submacular hemorrhage: Three case reports. World J Clin Cases 2026; 14(6): 118545 [DOI: 10.12998/wjcc.v14.i6.118545]
Corresponding Author of This Article
Yehya Tlaiss, MD, Department of Ophthalmology, Clemenceau Medical Center, Hazmieh, The Backyard Street, Ghazal Hills, Beirut 1100, Beyrouth, Lebanon. yehyatlaiss@hotmail.com
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Ophthalmology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 26, 2026 (publication date) through Feb 13, 2026
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World Journal of Clinical Cases
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2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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El Mollayess G, Jaroudi M, Tlaiss Y, Itaoui R, Abiad B. Surgical management of acute choroidal neovascularization related submacular hemorrhage: Three case reports. World J Clin Cases 2026; 14(6): 118545 [DOI: 10.12998/wjcc.v14.i6.118545]
World J Clin Cases. Feb 26, 2026; 14(6): 118545 Published online Feb 26, 2026. doi: 10.12998/wjcc.v14.i6.118545
Surgical management of acute choroidal neovascularization related submacular hemorrhage: Three case reports
Georges El Mollayess, Mahmoud Jaroudi, Yehya Tlaiss, Rayan Itaoui, Bachir Abiad
Georges El Mollayess, Bachir Abiad, Department of Ophthalmology, Lebanese American University, Beirut 1100, Beyrouth, Lebanon
Mahmoud Jaroudi, Yehya Tlaiss, Rayan Itaoui, Bachir Abiad, Department of Ophthalmology, Clemenceau Medical Center, Beirut 1100, Beyrouth, Lebanon
Author contributions: El Mollayess G contributed to data curation; Jaroudi M contributed to conceptualization; investigation; Tlaiss Y contributed to study design; project administration; writing - original draft; Itaoui R contributed to investigation; data extraction; visualization (figures/tables); El Mollayess G and Abiad B contributed to surgical procedures/clinical oversight, supervision; Jaroudi M and Abiad B contributed to writing - review & editing.
Informed consent statement: Written informed consent was obtained from all patients for the surgical procedures and for publication of their clinical data and accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yehya Tlaiss, MD, Department of Ophthalmology, Clemenceau Medical Center, Hazmieh, The Backyard Street, Ghazal Hills, Beirut 1100, Beyrouth, Lebanon. yehyatlaiss@hotmail.com
Received: January 6, 2026 Revised: January 24, 2026 Accepted: February 5, 2026 Published online: February 26, 2026 Processing time: 39 Days and 7.7 Hours
Abstract
BACKGROUND
Acute submacular hemorrhage (SMH) secondary to choroidal neovascularization (CNV), most commonly in neovascular age-related macular degeneration, is a vision-threatening emergency. Thick, fovea-involving SMH can cause rapid photoreceptor injury, and timely intervention aimed at clot lysis and displacement, while continuing CNV suppression with anti-vascular endothelial growth factor (anti-VEGF) therapy, may improve anatomic outcomes.
CASE SUMMARY
We report a retrospective case series of three eyes with acute, fovea-involving CNV-related SMH treated with pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (tPA), and expansile gas tamponade, with intravitreal anti-VEGF administered at the end of the procedure and continued postoperatively. Two cases had early intraocular pressure-related events (transient hypotony in one patient and transient ocular hypertension in another) requiring close postoperative monitoring and medical management. Follow-up color fundus photography and optical coherence tomography documented postoperative evolution of the hemorrhage compared with baseline, with ongoing anti-VEGF therapy planned to control the underlying CNV.
CONCLUSION
PPV with subretinal tPA and gas tamponade is a practical surgical strategy for acute, thick, fovea-involving SMH secondary to CNV, particularly when rapid displacement is desired. Careful documentation of operative parameters, strict postoperative monitoring for pressure-related complications, and continued anti-VEGF therapy are essential components of care.
Core Tip: Acute submacular hemorrhage (SMH) secondary to choroidal neovascularization (CNV) is a vision-threatening emergency with no universal management consensus. This case series highlights the role of pars plana vitrectomy with subretinal tissue plasminogen activator, gas tamponade, and adjunct anti-vascular endothelial growth factor therapy for rapid foveal blood displacement. By integrating representative cases with contemporary evidence, we propose a practical, case-based treatment algorithm to guide timely surgical decision-making and postoperative management in severe CNV-related SMH.
