title: Management of submacular hemorrhage with intravitreal sulfur hexafluoride: a pilot study.
abstract: BACKGROUND
  Some success has been reported with the intravitreal use of tissue plasminogen activator (tPA) and perfluoropropane gas in the management of large submacular hemorrhages. However, the dosage of tPA that has been used (100 micrograms) has a narrow margin of safety, and it remains to be shown that intravitreal tPA can cross the retina and effect subretinal clot lysis. We carried out a pilot study to evaluate the efficacy of intravitreally administered sulfur hexafluoride (SF6) gas alone in the management of large submacular hemorrhages secondary to age-related macular degeneration (AMD).
  
  
  METHODS
  Three patients with large submacular hemorrhages secondary to AMD seen at a university-affiliated teaching hospital in Ottawa were treated with an intravitreal injection of 0.6 mL of SF6 gas. They were instructed to assume a prone position for 7 to 10 days. The patients were followed 3, 7, 14 and 28 days after the procedure and monthly thereafter for at least 6 months. Colour photography and fluorescein and indocyanine green angiography were performed immediately before and 2 weeks after the procedure and, thereafter, at the discretion of the treating ophthalmologist.
  
  
  RESULTS
  In all three cases significant inferior displacement of the submacular blood was observed. Two patients showed an improvement of vision from counting fingers to 20/70 and to 20/200. In one case the submacular blood was displaced such that laser photocoagulation of a juxtafoveal choroidal neovascular membrane became possible.
  
  
  CONCLUSIONS
  The results suggest that intravitreally administered SF6 alone may have a role in the management of selected cases of neovascular AMD complicated by significant submacular hemorrhage. These results call into question the utility of adjunctive intravitreal tPA in such cases.
authors.affiliation: University of Ottawa Eye Institute, Ont.
authors.forename: H
authors.initials: H
authors.lastname: Daneshvar
authors.forename: P J
authors.initials: PJ
authors.lastname: Kertes
authors.forename: B C
authors.initials: BC
authors.lastname: Leonard
authors.forename: G A
authors.initials: GA
authors.lastname: Peyman
mesh_terms: D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007208:Indocyanine Green; D007267:Injections; D008266:Macula Lutea / Q000187:drug effects* / Q000473:pathology; D008268:Macular Degeneration / Q000150:complications; D010865:Pilot Projects; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D013459:Sulfur Hexafluoride / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D007208:Indocyanine Green; D013459:Sulfur Hexafluoride