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Laila T. Hashemi, Vegard A. Forsaa; Vitrectomy and Submacular Tissue Plasminogen Activator in the Management of Acute Submacular Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6135.
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To evaluate the efficacy of submacular injection of tissue plasminogen activator (tPA) in combination with vitrectomy and gas- or air- tamponade in the treatment of acute submacular hemorrhage (SMH).
A retrospective case series of 7 consecutive patients with acute SMH treated with vitrectomy and submacular tPA injection in Stavanger University Hospital, Norway, between October 2008 and August 2010. Primary outcome measures were change in visual acuity (VA) at visit closest to 6 months after surgery compared to baseline VA and displacement of hemorrhage.
7 patients, 6 females and 1 male, were identified. Mean age was 79.4 (range 62 - 90) years. All procedures were carried out by a single surgeon (VAF), who performed 23-gauge pars plana vitrectomy followed by submacular injection of tPA (20 - 50 microgr.) with a 38-gauge cannula and fluid-air exchange. 3 patients received air-tamponade only, while 2 patients received tamponade with SF6 gas (24 - 30%) and 2 patients with C2F6 gas (16 - 18%). 5 patients received intravitreal anti-VEGF agent at the end of surgery, and 6 patients received additional treatment with intravitreal anti-VEGF agent within the first 6 months after surgery. 4 patients had follow up of minimum 6 months, while 3 patients were followed for 2 - 5 months. Mean symptom duration before surgery was 21 (range 2 - 37) days, and mean delay from 1st visit until surgery was 7 (range 1 - 22) days. Mean pre-operative VA was 1.40 (range 0.60 - 2.00) logMAR, and mean VA at visit closest to 6 months post-surgery was 0.77 (range 0.40 - 1.20) logMAR. The mean ETDRS letter gain was 31.5 (p = 0.03). VA improved by more than 3 (range 5 - 16) lines in 4 patients, by 1 line in 2 patients and remained unchanged in 1 patient. Displacement of SMH was achieved in 6 patients and failed in 1 patient.
The findings indicate that vitrectomy and submacular tPA injection in combination with air- or gas- tamponade may fascilitate improvement of VA and displacement of hemorrhage in acute SMH.
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