The natural history for SMH is usually poor; so many investigators have attempted to find effective surgical options. There is a wide variation of PD success reported and several treatment strategies, but there are no consensus or treatment guidelines regarding optical management. Nevertheless, with the advances in vitreoretinal surgery, there continues to evolve novel management strategies for SMH. This is a largest series which was born in a move to find out a definite protocol to effectively manage cases of SMH which had different causes of their bleed. It is seen in this study that SMH if reported within a week of symptoms after PD can have a better visual prognosis than late presentation. The final visual prognosis revolves around the cause for SMH. The reason why tPA was not used, was due to its non-availability readily, expensive and thinking about the complications of its use, though many reports are present suggesting its use to be safer. PD in this series was done in the next day of the presentation as an emergency procedure. Pure perfluoropropane gas (0.3ml) injected into the vitreous cavity can displace SMH without the use of tPA in all cases. Visual acuity after gas injection improves, making this treatment an alternative to evacuation of SMH. This also helps to find out the cause for SMH after the displacement of the haemorrhage.
