Successful treatment of acute subretinal hemorrhage in age-related macular degeneration by combined intravitreal injection of recombinant tissue plasminogen activator and gas.
Subretinal hemorrhage secondary to age-related macular degeneration (AMD) has a poor visual prognosis. Surgical drainage of the blood improves visual acuity only in selected patients. We report on two elderly patients with spontaneous subretinal hemorrhage from AMD. In one eye, recombinant tissue plasminogen activator (rTPA), combined with a long-acting gas (SF6), was injected into the vitreous cavity. The other eye was treated first by gas instillation followed 3 days later by rTPA injection. Both treatments led to nearly complete displacement of the subretinal hemorrhage from the macular region. In both eyes, an inferior exudative retinal detachment reabsorbed spontaneously within 2 weeks. Bilateral vitreous opacities after rTPA injection resolved without further treatment. Postoperative visual acuity increased to 0.3 and 0.4. The combined treatment is a valuable method for management of acute subretinal hemorrhage. Rapid displacement of this abnormality can minimize clot-induced damage of the highly sensitive macula and increase visual acuity.
Hesse
L
L
Department of Ophthalmology, Philipps-University of Marburg, Federal Republic of Germany.
Kroll
P
P
D000368:Aged; D000375:Aging / Q000473:pathology*; D005260:Female; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage*; D012163:Retinal Detachment / Q000188:drug therapy*; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity