Preoperative use of tissue plasminogen activator for large submacular hemorrhage.
OBJECTIVE
Tissue Plasminogen Activator (TPA) has been used as an adjunct in the surgical removal of submacular hemorrhage. It is usually used intraoperatively, but may not provide enough time for effective fibrinolysis, especially for a large hemorrhage. The present study was conducted to evaluate the efficiency and safety of preoperative use of TPA for large submacular hemorrhages.


METHODS
Five eyes with large submacular hemorrhage secondary to age-related macular degeneration underwent subretinal injection of TPA in the office 24 hours before surgery. All hemorrhages were less than seven days old and at least 3 mm thick.


RESULTS
Preoperative visual acuity ranged from counting fingers to hand motion (HM). Patient follow-up ranged from 3 months to 24 months (mean, 11 months). Final visual acuity ranged from 20/30 to HM. Four of the five eyes (80%) showed improved visual acuity after surgery and 3/5 (60%) attained visual acuity of 20/200 or better.


CONCLUSIONS
Preoperative use of TPA for drainage of large submacular hemorrhage appears to be safe and may result in efficient clot removal. The true efficacy of TPA in the treatment of submacular hemorrhage can only be proven by a prospective randomized trial.
Chaudhry
N A
NA
Department of Ophthalmology, Yale University School of Medicine, New Haven, CT, USA.
Mieler
W F
WF
Han
D P
DP
Alfaro
V D
VD
Liggett
P E
PE
D000368:Aged; D000369:Aged, 80 and over; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications; D011300:Preoperative Care; D012166:Retinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D012449:Safety; D013396:Suction; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator