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R Boada, R Cady, J Wells, W Clark, C Goins, D Saperstein; Tissue Plasminogen Activator (t-PA) assisted Subfoveal Hemorrhage Displacement Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3521.
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Purpose: To describe subfoveal hemorrhage displacement (SFHD) to treat subretinal, subfoveal hemorrhage secondary to choroidal neovascular membranes (CNV). Methods: SFHD cases from 3 retina surgeons were reviewed retrospectively. 16 eyes were followed from 0-13 months post SFHD. Surgery involved complete vitrectomy with removal of the posterior hyaloid and subretinal injection of t-PA (6-25 micrograms/0.1 cc) into the area of subfoveal hemorrhage. Inferior detachment of the retina was performed either directly with the t-PA injection or subsequently with balanced salt solution using a 30-41 gauge cannula. A 50% gas fluid exchange was performed and approximately 40 minutes after the t-PA injection the patient was placed in an upright position and remained that way for 24 hours. Within the first post operative week, fluorescein angiography was done to visualize the etiology of the hemorrhage. Lesions that were considered treatable by photodynamic therapy (PDT) guidelines were treated accordingly. Results: 16 eyes received SFHDand were followed for 0-13 months. The subretinal hemorrhage was displaced away from the fovea in 16/16 eyes. 9/16 eyes improved by 3 or greater lines of Snellen visual acuity. 3/16 eyes maintained acuity. 3/16 eyes lost 3 or greater lines of visual acuity. 1/16 is post operative day 1 at the time of abstract submission. PDT was administered in 3/16 eyes that had predominantly classic lesions on their post operative angiograms. Complications included 2 eyes in which rebleeding occured. Conclusion: Tissue plasminogen activator assisted subfoveal hemorrhage displacement surgery may provide a superior method of managing subretinal hemorrhage as compared to observation and existing therapies.
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