Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas.
OBJECTIVE
To assess the effects of intravitreal injection of recombinant tissue plasminogen activator (rTPA) and gas on submacular hemorrhage in age-related macular degeneration (ARMD).


METHODS
Eleven consecutive patients (11 eyes) with subretinal hemorrhage due to ARMD involving the fovea with elevation of the neurosensory retina were included in this study. Subretinal hemorrhage occured 12 h to 14 days before onset of therapy. Injection of rTPA through the pars plana in a dose of 50 or 100 microg was performed. Gas instillation (0.2-0.4 ml) followed rTPA injection, either immediately after injection (7 patients) or during the following day (4 patients).


RESULTS
After intravitreal injection of rTPA, subretinal clots were totally or partially liquefied when treatment started up to 3 days after onset of bleeding. In all patients treated with 100 microg rTPA a large exudative retinal detachment of the inferior retina resulted, which reabsorbed spontaneously within 2 weeks. After reattachment of the exudative retinal detachment hyperpigmentation of the retinal pigment epithelium was noted. Temporary opacification of the vitreous was observed between the 2nd and 7th postoperative day in 5 eyes (45.5%). Postoperative visual acuity increased in 5 patients (45.5%).


CONCLUSIONS
Intravitreal application of rTPA followed by gas injection is a sufficient and convenient technique for effective removal of freshly formed submacular hemorrhage. Removal is mediated through combined enzymatic (rTPA) and mechanical (gas) effects. This technique offers a quick recovery of vision in eyes with less severe ARMD.
Hesse
L
L
Department of Ophthalmolgy, Philipps University, Marburg, Germany.
Schmidt
J
J
Kroll
P
P
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004596:Electroretinography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D005466:Fluorocarbons / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014822:Vitreous Body
D005343:Fibrinolytic Agents; D005466:Fluorocarbons; D011994:Recombinant Proteins; C042852:perflutren; D010959:Tissue Plasminogen Activator