Focal macular electroretinogram before and after drainage of macular subretinal hemorrhage

PURPOSE: To record and evaluate change in preoperative and postoperative macular electroretinograms in patients undergoing surgical drainage of macular subretinal hemorrhage. METHODS: Five eyes of five patients with good visual acuity before onset of hemorrhage underwent vitrectomy between 3 and 14 days after developing hemorrhage, with drainage of submacular hemorrhage, using recombinant tissue plasminogen activator. The causes of subretinal hemorrhage were macroaneurysm in three eyes, age-related macular degeneration in one eye, and unknown in one eye. Visual acuity and macular electroretinograms were recorded preoperatively and postoperatively. RESULTS: In all eyes, preoperative electroretinographic response was remarkably reduced or not recordable. Postoperative visual acuity improved, and electroretinographic response recovered to about one half the amplitude of the fellow eye in every eye with a normal fellow eye. CONCLUSIONS: A nearly nonrecordable preoperative response on macular electroretinogram indicates severe dysfunction of the photoreceptors caused by the submacular hemorrhage. A postoperative recovered macular electroretinogram suggests that photoreceptor function is at least partially reversible with surgical intervention, including injection of recombinant tissue plasminogen activator into the subretinal space.