Management of submacular hemorrhage associated with retinal arterial macroaneurysms.
OBJECTIVE
Experience is reported with intraoperative pharmacologic lysis of recent submacular hemorrhage with tissue plasminogen activator followed by surgical drainage of the unclotted blood in patients with retinal arterial macroaneurysms.


METHODS
Nine eyes (nine patients) with a recent (< or = 7 days old) submacular hemorrhage involving the center of the fovea secondary to retinal arterial macroaneurysm that were managed with recombinant tissue plasminogen activator-assisted subretinal hemorrhage evacuation, including subretinal injection of tissue plasminogen activator and removal of the liquefied blood. Patients were followed for a mean 18 +/- 7 months (range, 7 to 30 months).


RESULTS
All nine eyes had improved final corrected visual acuity after surgery, and eight eyes (89%) attained a corrected visual acuity of 20/60 or better (mean, 20/40; range, 20/20 to 20/200). Final corrected visual acuity was limited to 20/200 in one eye. Two eyes developed a cataract that required surgery.


CONCLUSIONS
Submacular surgery with tissue plasminogen activator-assisted thrombolysis achieved improved best-corrected visual acuity in eyes with recent submacular hemorrhage involving the center of the fovea associated with retinal arterial macroaneurysm.
Humayun
M
M
Division of Ophthalmology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Lewis
H
H
Flynn
H W
HW
Sternberg
P
P
Blumenkranz
M S
MS
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005584:Fovea Centralis; D006801:Humans; D008266:Macula Lutea; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012161:Retinal Artery; D012164:Retinal Diseases / Q000150:complications; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity
D011994:Recombinant Proteins; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator