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J. A. Feistmann, R. C. Gentile, A. Ponce, T. O. Muldoon, V. Doshi, R. B. Rosen; Treatment of Acute Subretinal Hemorrhage With Subretinal Tissue Plasminogen Activator (tPA) Injetion Administered via Pars Plana Vitrectomy With Gas Fluid Exchange. Invest. Ophthalmol. Vis. Sci. 2008;49(13):590.
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To review eight cases of acute subretinal hemorrhage treated with subretinal tPA injection via pars plana vitrectomy, air fluid exchange and gas injection.
Retrospective chart review of eight consecutive patients, ages 24 to 87, treated for acute subretinal hemorrhage, present for four weeks or less, was performed. Etiologies of the hemorrhage included: exudative age related macular degeneration in five cases, choroidal neovascularization secondary to toxoplasmosis in one, pathologic myopia in one, and blunt trauma in one. In four cases the subretinal hemorrhage extended beyond the vascular arcades, and in the remaing four, the hemorrhage was two to three disc diameters in size and was contained within the arcades. In all cases, pars plana vitrectomy, subretinal injection of 0.1cc of tissue plasminogen activator (25 µg/ml) with a 39 gauge needle, air fluid exchange and gas injection was performed to induce pneumatic displacement of the subretinal hemorrhage.
The subretinal hemorrhage was successfully displaced inferior to the macula in all eight cases. The vision improved in five cases: from hand motions to 20/40, 20/200 to 20/40, counting fingers to 20/100, counting fingers to 20/150, and 20/100 to 20/50. The remaining three cases which were noted to have pre-existent subfoveal scarring, showed only slight improvement from counting fingers vision to 20/400 in one case and no change from pre-operative 20/400 and hand motions vision in the other two cases. However, all of these three patients noted a subjective improvement in their vision consistent with expansion of paracentral fields in the areas of displaced submacular hemorrhage surrounding the central scars.
Subretinal tPA injection delivered via pars plana vitrectomy with air fluid exchange and gas injection appears to be a safe, effective way to displace acute subretinal hemorrhage from the macula which often produces in significant vision improvement.
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