a 65-year - old male patient presented to us with diminution of vision of one - day duration in the right eye . the best - corrected - visual - acuity ( bcva ) in the right eye was 10/200 . fundus of the eye showed an smh along with a large pigmentary epithelial detachment ( ped ) [ fig . leakage of the dye on indocyanine green angiography ( icg ) and variable reflectivity on optical coherence tomography ( oct ) suggested a subfoveal cnvm [ fig . 2 ] . red free image of right eye showing submacular hemorrhage ( blue arrow ) along with pigmentary epithelial detachment ( red arrow ) optical coherence tomography showing variable reflectivity of the retinal pigmentary epithelium ( blue arrow ) suggestive of choroidal neovascular membrane with subretinal blood and large pigmentary epithelial detachment ( red arrow ) a 62-year - old male presented with sudden diminution of vision in the right eye since one week . oct showed variable reflectivity of the retinal pigment epithelium ( rpe ) along with an increase in the retinal thickness suggestive of subfoveal cnvm with macular edema . a 35-year - old female presented to us with diminution of vision in the left eye since seven days . patient had undergone refractive surgery for myopia 10 years back . left eye fundus showed a subretinal hemorrhage and oct showed hyper - reflectivity in the rpe suggestive of cnvm . a 65-year - old female came to us with complaint of diminution of vision in the left eye since one week . . left eye fundus showed smh along with chorio - retinal atrophy at the edge . ffa showed blocked fluorescence in the area of hemorrhage with late hyperfluorescence of the chorioretinal atrophy . all patients were given an intravitreal injection of 1.25 mg or 0.05 ml bevacizumab ( one vial of bevacizumab contains 100 mg in 4 ml ) along with pneumatic displacement of the smh by 0.4 - 0.5 ml of sf6 [ micro sf , micromed s.r.l , italy ] . intravitreal gas was injected using 30 g needles ( pricon , iscon surgicals ltd . , a 65-year - old male patient presented to us with diminution of vision of one - day duration in the right eye . the best - corrected - visual - acuity ( bcva ) in the right eye was 10/200 . fundus of the eye showed an smh along with a large pigmentary epithelial detachment ( ped ) [ fig . leakage of the dye on indocyanine green angiography ( icg ) and variable reflectivity on optical coherence tomography ( oct ) suggested a subfoveal cnvm [ fig . 2 ] . red free image of right eye showing submacular hemorrhage ( blue arrow ) along with pigmentary epithelial detachment ( red arrow ) optical coherence tomography showing variable reflectivity of the retinal pigmentary epithelium ( blue arrow ) suggestive of choroidal neovascular membrane with subretinal blood and large pigmentary epithelial detachment ( red arrow ) a 62-year - old male presented with sudden diminution of vision in the right eye since one week . oct showed variable reflectivity of the retinal pigment epithelium ( rpe ) along with an increase in the retinal thickness suggestive of subfoveal cnvm with macular edema . a 35-year - old female presented to us with diminution of vision in the left eye since seven days . patient had undergone refractive surgery for myopia 10 years back . left eye fundus showed a subretinal hemorrhage and oct showed hyper - reflectivity in the rpe suggestive of cnvm . a 65-year - old female came to us with complaint of diminution of vision in the left eye since one week . . left eye fundus showed smh along with chorio - retinal atrophy at the edge . ffa showed blocked fluorescence in the area of hemorrhage with late hyperfluorescence of the chorioretinal atrophy . all patients were given an intravitreal injection of 1.25 mg or 0.05 ml bevacizumab ( one vial of bevacizumab contains 100 mg in 4 ml ) along with pneumatic displacement of the smh by 0.4 - 0.5 ml of sf6 [ micro sf , micromed s.r.l , italy ] . intravitreal gas was injected using 30 g needles ( pricon , iscon surgicals ltd . , treatment , if delayed , leads to poor recovery due to the delay in diagnosis and treatment of the primary pathology as well as due to the harmful effect of persistent subretinal blood on photoreceptors . treatment options have included cnvm and hemorrhage removal with forceps , pneumatic displacement with/ without intravitreal tissue plasminogen activator ( tpa ) , injection of subretinal tpa with displacement by perfluorocarbon liquid , injection of subretinal tpa followed by hemorrhage evacuation , vitrectomy with intravitreal/ subretinal injection of tpa with an intraocular gas bubble to help displace the hemorrhage inferiorly . previously , pneumatic displacement was the treatment of choice in patients of smh in cnvm , at our center . subsequent management of the underlying pathology used to be done in a second sitting . with the widespread use of intravitreal bevacizumab in treatment of wet amd , we decided to combine the two approaches for a faster visual recovery . intravitreal injection of sf6 displaces the hemorrhage from the macular area , allowing for increase in visual acuity as well as better visualization of the primary pathology . india being a developing country with limited availability and high cost of tpa , bevacizumab seemed a good alternative . this resulted in a better definitive delineation of the primary pathology on subsequent ffa and oct [ figs . 3 and 4 ] . red free image of the right eye showing clearing of submacular hemorrhage after intra - vitreal bevacizumab and sf6 injection ( red arrow ) optical coherence tomography of the same patient showing normal reflectivity of the retinal pigmentary epithelium after the procedure with normal foveal contour ( red arrow ) gopalakrishan et al . , have reported a series of 20 cases of smh who were treated with pneumatic displacement out of which five had amd . in these patients in contrast , all the four cases in our series had good recovery of visual acuity . this is an observation with very few patients but seems a promising technique in patients of amd with smh . since earlier studies have had poor results with the other techniques available , more patients need to undergo this treatment for a better analysis of outcome .
choroidal neovascular membrane ( cnvm ) is one of the most common causes of submacular hemorrhage ( smh ) . 
 conventional treatment involves management of the smh with pneumatic displacement with or without tissue plasminogen activator ( tpa ) followed by intravitreal injection of bevacizumab in a second sitting . 
 we decided to assess the efficacy of treating smh secondary to cnvm with pneumatic displacement using sulphur hexafluoride ( sf6 ) gas and intravitreal bevacizumab . 
 four patients with smh secondary to cnvm were included in this study . 
 intravitreal bevacizumab , 0.05 ml , along with 0.5 ml of sf6 was injected through the pars plana into the vitreous cavity . 
 postoperative best corrected visual acuity improved in all eyes with complete or partial displacement of smh out of the foveal area .