Purchase this article with an account.
R. Singh, C. Patel, J.E. Sears; Management of Subretinal Macular Hemorrhage by Direct Administration of Tissue Plasminogen Activator . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1472.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Recent studies on the treatment of acute subretinal macular hemorrhage have shown that the volume of the clot and the time to evacuation have strong prognostic factors on visual outcome. The purpose of this study was to evaluate a novel technique for surgical evacuation of these lesions involving direct injection of tissue plasminogen activator into the hematoma using pars plana vitrectomy.
Seventeen consecutive patients with subretinal macular hemorrhages due to age–related macular degeneration were enrolled. Patient demographics, acuities, and fluorescein angiograms were obtained for all evaluations. All patients underwent complete 3–port pars plana vitrectomy to enable direct cannulation of the subretinal space and injection of 48 ug of tissue plasminogen activator, partial fluid–air exchange, one hour face–up supine positioning postoperatively, followed by upright positioning overnight.
Eighty–eight percent of patients with in the study had stabilization or improvement of visual acuity. Nine patients had total clearing of the macular hemorrhage and 8 patients had subtotal clearing. Two patients had recurrence of the hemorrhage after the procedure and one patient underwent repair for retinal detachment. Occult lesions demonstrated similar outcomes to classic or predominately classic lesions. Nine patients required no therapy after the study to treat subfoveal neovascularization.
This study represents one of the largest series of patients to date showing that direct injection of subretinal tissue plasminogen activator with air fluid exchange only and no intra–operative clot lysis period can have favorable results.
This PDF is available to Subscribers Only