Purpose:
To study the characteristics and outcomes of eyes having undergone 25 gauge pars plana vitrectomy with submacular tissue plasminogen activator (tPA) and gas tamponade for submacular hemorrhage in wet macular degeneration.
Methods:
Retrospective, noncomparative case series of 18 eyes that underwent 25 gauge vitrectomy with submacular tPA and gas tamponade in an effort to displace submacular hemorrhage.
Results:
After a mean follow–up of 10.2 months (range, 1–36 months) the average visual acuity improved 2.61 lines. 10 patients gained three or more lines of visual acuity while 3 patients lost three or more lines. 5 patients had improved visual acuities from 20/200 or worse to 20/70 or better. Procedures following displacement of the submacular hemorrhages included subsequent photodynamic therapies (15), intravitreal triamcinolone injections (9), retinal detachment repairs (2), transpupillary thermotherapy (1), and intravitreal pegaptanib (1). All surgeries were performed via 25 gauge pars plana vitrectomy as opposed to 20 gauge pars plana vitrectomy.
Conclusions:
Large submacular hemorrhages have poor natural histories with potentially devastating impact on vision. 25 gauge pars plana vitrectomy with injection of submacular tPA and gas bubble tamponade seems to be a safe way to displace these hemorrhages. This can lead to improved visual outcomes as well as aid in subsequent diagnosis and treatment of the underlying etiology that would otherwise have been impossible.
Keywords: age-related macular degeneration • macula/fovea • retina