title: Tissue plasminogen activator in the surgical management of subretinal haemorrhage.
abstract: We report three cases of the use of tissue plasminogen activator (TPA) to aid the surgical removal of subretinal haemorrhage. All patients had choroidal neovascular membranes secondary to age-related macular degeneration. The technique involved infusing a sterile solution of TPA through a small retinotomy and irrigating out the dissolved clot. The visual acuity improved in the first patient from a preoperative 6/36 to 6/18 five weeks after surgery, but subsequently deteriorated to 6/60 after six months from a new choroidal neovascular membrane (CNVM), remaining 6/60 at nine months after surgery. The second patient's visual acuity improved from count fingers to 6/24 three weeks after surgery, but subsequently deteriorated to 6/60 after four months from a new CNVM, remaining 6/60 at nine months after surgery. The third patient's visual acuity improved from count fingers to 6/36 and remains stable at 6/36, eight months after surgery. Although long-term prognosis remains guarded, these early results suggest that TPA may have a role in the management of subretinal haemorrhage.
authors.affiliation: Mater Misericordiae Hospital, Brisbane.
authors.forename: L M
authors.initials: LM
authors.lastname: Manning
authors.forename: D K
authors.initials: DK
authors.lastname: Conrad
mesh_terms: D000368:Aged; D002829:Choroid / Q000098:blood supply; D003131:Combined Modality Therapy; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008268:Macular Degeneration / Q000150:complications; D008297:Male; D009389:Neovascularization, Pathologic / Q000209:etiology; D011379:Prognosis; D012166:Retinal Hemorrhage / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014792:Visual Acuity; D014821:Vitrectomy
chemical_list: D010959:Tissue Plasminogen Activator