An 80-year-old man came to the emergency department with a decrease in visual acuity (VA) in the right eye (OD) of 2 days' evolution.
His medical history included: hypertension and dyslipidaemia under treatment, chronic bronchitis and a transient ischaemic accident requiring antiplatelet therapy with aspirin.
The ophthalmological examination in the emergency department was as follows. VA by OD: light perception (LP); by left eye (LO): 1; afferent pupillary defect of the LO 3+/4+; intraocular pressure of the LO: 16; LO: 17; biomicroscopy was normal and funduscopy showed a subretinal haemorrhage of 6 × 10 papillary diameters at the level of the posterior pole, including the macular area.

An angiofluoresceingraphy (AFG) was performed, confirming the subretinal location of this haemorrhage, together with an inferior juxtafoveolar hyperfluorescent area at late times, indicating the presence of a neovascular membrane (NVM) at that level.

Two days later, 25 μg of r-TPA in a volume of 0.1 ml was injected intravitreally, followed by a 0.3 ml injection of pure sulphur hexafluoride (SF6) and a 0.2 ml anterior chamber evacuation paracentesis.
After 3 days, he came for a check-up and it was observed that the blood had partially shifted from the posterior pole, together with areas of fibrin.

One month after this procedure, the patient was seen again with a VA of 0.05 and the funduscopy showed a decrease in the haemorrhage, although the blood persisted in the macular area and fibrin in the lower area.

One month later, the patient came for a check-up and funduscopy revealed a subretinal haemorrhage of similar extent to that seen at diagnosis, so he was diagnosed with haemorrhagic AMD and a course of 3 doses of intravitreal ranibizumab was prescribed.

After the ranibizumab cycle, he came to the hospital for a check-up and showed a VA of PL in the OD and 1 in the OI. Funduscopy revealed the presence of haemolithiasis that prevented adequate visualisation of the posterior pole structures.
At the present time, the patient is still under study to assess the next therapeutic step.