title: Submacular hemorrhage removal.
abstract: OBJECTIVE
  To determine whether pars plana vitrectomy combined with tissue plasminogen activator for evacuation of submacular hemorrhage results in improved visual acuity.
  
  
  METHODS
  Retrospective review of 18 patients who received a subretinal injection of tissue plasminogen activator during a pars plana vitrectomy to evacuate dense submacular hemorrhages.
  
  
  RESULTS
  Diagnoses included age-related macular degeneration (16 patients), ruptured macroaneurysm (1 patient), and penetrating ocular trauma (1 patient). Preoperative visual acuity ranged from 20/200 to counting fingers (median visual acuity, counting fingers). Follow-up ranged from 10 to 104 weeks (median, 33 weeks). Best postoperative visual acuity ranged from 20/30 to counting fingers (median, 20/300). Best postoperative visual acuity improved two or more lines in 11 (61%) of 18 eyes, remained unchanged in 4 (22%) of 18 eyes, and decreased two or more lines in 3 (17%) of 18 eyes (P = 0.10, Wilcoxon sign-rank test). Final visual acuity ranged from 20/40 to light perception (median, counting fingers). Final visual acuity improved two or more lines in 5 (28%) of 18 eyes, remained unchanged in 6 (33%) of 18 eyes, and decreased two or more lines in 7 (39%) of 18 eyes (P = 0.53, Wilcoxon sign-rank test).
  
  
  CONCLUSIONS
  Pars plana vitrectomy to evacuate massive subretinal hemorrhage can improve visual acuity, but final visual acuity is limited by the underlying disease.
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Lim
authors.forename: C
authors.initials: C
authors.lastname: Drews-Botsch
authors.forename: P
authors.initials: P
authors.lastname: Sternberg
authors.forename: A
authors.initials: A
authors.lastname: Capone
authors.forename: T M
authors.initials: TM
authors.lastname: Aaberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008266:Macula Lutea; D008268:Macular Degeneration / Q000150:complications; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000150:complications / Q000601:surgery; D010960:Plasminogen Activators / Q000627:therapeutic use*; D012166:Retinal Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator