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M. Groppe, R. Girgis, M. Khandwala, C. Kon, S. Rassam; Intravitreous Injection of Tissue Plasminogen Activator and Pneumatic Displacement of Acute Submacular Hemorrhage . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1444.
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To investigate the visual outcome and safety of treating submacular hemorrhages with intravitreous recombinant tissue plasminogen activator (rt–PA) and gas.
Retrospective, non–comparative, interventional case series. Fourteen consecutive cases (mean age 77 years) with recent submacular hemorrhage secondary to age related macular degeneration or macroaneurysm were treated with intravitreous injection of rt–PA (25µg) and followed by 0.3 ml gas injection (C3F8). Postoperative positioning was advised for one week. Patient follow–up ranged from 2 to 23 months (mean 8 months). Initial, best and final visual acuity was measured in relation to onset of hemorrhage. Surgical complications were recorded.
Best postoperative visual acuity compared with preoperative visual acuity was improved two or more Snellen lines in 5 eyes (36%) and stable (identical or improvement of one line) in 9 eyes (64%). The duration of hemorrhage was not associated with improvement in visual acuity. Even late treatment showed significant benefit. No intraoperative and postoperative complications were noted. One patient developed a retinal detachment two months after the treatment. Three patients needed further treatment (focal laser, vitrectomy) for their primary condition.
These findings suggest that intravitreous injections of rt–PA and gas are of value for an improvement of visual acuity in patients with submacular hemorrhage. The time between onset of symptoms and treatment is not significantly associated with visual outcome. Nevertheless a rapid displacement of submacular blood may open up the possibility of further treatment of the underlying condition. The rate of complication during and post operation was low, so that this treatment may be considered to be very safe.
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