Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement
Section snippets
Patients and methods
We reviewed the medical records of 15 consecutive patients who had undergone intravitreous injection of commercial tPA solution and expansile gas for thrombolysis and displacement of submacular hemorrhage. Patients presenting at several centers to one of the authors (M.W.J., T.E.S., C.D.R., P.E.T., L.S.P., B.A.B., or S.G.E.) were accumulated retrospectively and accrued between January 1, 1997, and October 15, 1997. All patients had acute hemorrhages (<3 weeks old), thick blood under the fovea,
Results
Fifteen eyes of 15 patients (12 women) were included in the study. Patient age ranged from 13 to 91 years (median, 78 years). The mean duration of submacular hemorrhage was 5.7 days (range, 1–21 days), and the maximum diameter of the hematoma ranged from 2 to 13 disc diameters. The cause of the hemorrhage was choroidal neovascularization complicating ARMD in 13 eyes and macroaneurysm and trauma in 1 eye each (Table 1).
The procedure resulted in complete displacement of thick blood from under the
Discussion
Thick submacular hemorrhage, particularly in patients with ARMD, is generally associated with a poor visual outcome.1, 2, 3 Several mechanisms, including shearing of photoreceptors by fibrin clots, physical separation of photoreceptors from the retinal pigment epithelium, and toxic effects of iron, have been suggested as explanations for the retinal damage caused by thick subretinal blood.5, 6, 7, 20, 21 These natural history and experimental data have prompted the search for a safe and
Acknowledgements
The authors thank David C. Musch, PhD, for assistance in statistical analysis.
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