Displacement of Submacular Hemorrhage with Tissue Plasminogen Activator and Subretinal Air

Author: Alicia López de Eguileta (Spain)

Co-authors: Jaume Crespí, Jose Ignacio Vela, Jesús Díaz, Nuria Torrell

Purpose

To assess our surgical experience of using subretinal air injection in combination with recombinant tissue plasminogen activator (rtPA) at the time of pars plana vitrectomy (PPV) to displace submacular hemorrhage (SMH).

Setting/Venue

Retrospective, noncomparative, interventional case series.

Methods

Chart review of patients who underwent displacement of SMH with PPV, subretinal injection of air (0,2 ml) and rtPA (125 mg/mL), with partial fluid air-exchange with gas tamponade, and preoperative, intraoperative, or postoperative intravitreal injection of anti-vascular endothelial growth factor agent. The main outcomes measured were visual acuity (VA), the displacement of SMH from the fovea and the macular thickness.

Results

Twenty eyes of 20 patients were included (11 men; mean age 77.95) with a follow-up of 12 months.*SMH was due to age-related macular degeneration (AMD) in 16 patients, retinal arterial macroaneurysm in 3 patients and blunt ocular trauma in 1. One week after surgery, complete displacement from the foveal center was achieved of SMH was achieved in 19 no displacement was found 1 eye (5%). Residual subretinal pigment epithelial hemorrhage was seen in 13 eyes (65%). Mean preoperative VA was 1.96 (logMAR). Mean best corrected VA postoperative 1 week later was 2.07, and 1 and 3 months after surgery was 1.4 and 1.17 logMAR respectively. Mean central macular thickness (CMT) was 689.5 µm before treatment, and after 1 month it improved until 472.74 µm. Complications as retinal detachment, vitreous hemorrhage, and macular hole appeared in 25% of cases.

Conlusions

PPV with subretinal injection of rtPA and subretinal injection of air is an effective treatment of SMH in terms of complete displacement of the hemorrhage and VA recovery.

Financial Disclosure

No one

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