Abstract
Purpose :
In submacular hematoma migration using tissue plasminogen activator (tPA), the hematoma often migrates downward. If the lesion is above the macula, it can impair the normal macula during the hematoma migration process. We devised a method to control the direction of hematoma migration by selecting the site of tPA injection.
Methods :
The subjects were 18 patients who required hematoma migration by vitreous surgery. （polypoidal choroidal vasculopathy 12 cases , age-related macular degeneration 1 case , retinal arteriolar microaneurysm 5 cases）
Artificial retinal detachment was created by subretinal injection of tPA into the lower healthy retina from the ear side of the fovea. The posterior pole side of the retinal detachment was continuous with the submacular hematoma, and tPA was also infused with the lesion. The vitreous cavity was replaced with SF6, and the operation was completed. After the operation, he was instructed to look down and to lie down on the ear side.
Results :
The mean logMAR visual acuity improved from 1.12 ± 0.49 preoperatively to 0.49 ± 0.41 at 6 months postoperatively. The average foveal subretinal hematoma was 610±489 μm preoperatively and 68±134 μm one month postoperatively. The submacular hematoma moved downward from the ear side of the fovea in all cases. The average difference in the angle between the positions of the tPA injection centered on the fovea centralis and the hematoma post-movement one month after surgery was 26±25°. Postoperative submacular hematomas tended to migrate to artificial retinal detachment sites.
Conclusions :
Moving the hematoma to an artificial retinal detachment created by subretinal injection of tPA outside the lesion site by submacular hematoma migration and controlling the direction of hematoma migration are possible.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.