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R.H. Johnston, M. Chen, K. Wong, M. Levy; Surgical Displacement of Submacular Hemorrhage From Macular Degeneration With Vitrectomy, Subretinal Injection of tPA, Partialgas Fluid Exchange, and Postoperative Upright, Alternating With Prone Positioning . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1794.
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Purpose: To evaulate a modification of subretinal injection of tPA, and gas-fluid exchange for the treatment of submacular hemorrhage from macular degeneration. Methods: A retropsective review of all cases in the last year of submacular hemorrhage from AMD, treated with vitrectomy, injection of subretinal tPA, partial gas-fluid exchange, supine positioning for one hour post-operatively, followed by alternating upright and prone positioning. The primary outcome measure was the ability to successfully displace the subretinal blood from the fovea. The secondary outcome measure was the change in visual acuity. Any surgical complications were noted. Results: Eight cases, 5males and 3 females were evaluated. The mean age was 83 +/- 5 years (range 78-90). The mean follow up was 3 months (range 2-4). Successful displacement of the subretinal blood from the fovea was achieved in all eight cases. Visual acuity improved by two lines or more in three cases, stayed within two lines of initial vision in 4 cases, and worsened by greater than two lines in one case. Initial visual acuity ranged from 20/300 to Counting Fingers. Final Visual acuity ranged from 20/50 to Counting Fingers. No intraoperative or early postoperative complications occured. One patient had a recurrent subretinal hemorrhage 6 weeks following the surgery. Conclusions: This study confirms the effectiveness of vitrectomy, subretinal injection of tPA and fluid-gas exchange in displacing submacular haemorrhage. Modifications of a previously reported similar surgical technique include intial post-operative supine position, and partial gas-fluid exchange. Initial post-operative supine positioning for one hour may allow the tPA to more effectively lyse the clot. Partial fluid-gas exchange may be more effective in displacing the blood inferiorly as well as allow the patient to position upright part of the time.
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