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N. Kunjukunju, C. R. Gonzales, W. S. Rodden; Tissue Plasminogen Activator in the Treatment of Suprachoroidal Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6022.
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A vision threatening complication, suprachoroidal hemorrhages have a guarded prognosis and poor visual outcome is correlated with increased hemorrhage complexity. The recommended time of surgical drainage is 10-14 days after the hemorrhage begins to liquefy. We describe a case in which tissue plasminogen activator (tPA) is injected within the suprachoroidal space before surgery to assist in the drainage of an organized clot prior to liquefaction.
This is a report of a technique in which tPA is used in the intrachoroidal space to target the organized clot of suprachoroidal hemorrhage prior to drainage.
A 62-year-old male presents twelve days after retinal detachment repair with sudden ocular pain and vision loss after a valsalva maneuver. Vision was light perception and intraocular pressure was 43. Diagnosed with hyphema and suprachoroidal hemorrhage, the patient underwent surgery the following day. 100µg tPA was injected intracamerally and an additional 100µg tPA was injected into the intrachoroidal space prior to surgery. Liquified by tPA, the clot was expressed through the sclerotomies. Best corrected vision in the eye 8 months after the drainage procedure was 20/40
To our knowledge, this is the first reported case in which tPA was injected in the intrachoroidal space to successfully liquefy and drain a suprachoroidal hemorrhage prior to natural dissolution.
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