[Subretinal hematoma in age-related macular degeneration: treatment with intravitreal injection of tPA and gas].
OBJECTIVE
Subretinal hemorrhage involving the macula is a devastating complication of age-related macular degeneration. It may be successfully removed by vitrectomy but this surgery cannot be practiced in all patients. We propose an alternative way to this surgery by injecting tissue plasminogen activator then gas in the vitreous.


METHODS
We treated seven patients suffering from submacular hemorrhage for less than seven days. We injected in the vitreous 50 micrograms of tissue plasminogen activator followed seven days later by an another intravitreous injection of 0.3 milliliter of C3F8. The patient then had to stay in a "face down" position for seven days.


RESULTS
In five cases the subretinal hemorrhage was displaced enough to identify the choroidal neovascularization accountable for the bleeding in four cases. In one case, the displacement of the subretinal hematoma was incomplete but enough to identify and treat the neovascular membrane. In one case the injections were unsuccessfull. One recurrence occurred after four days after an initial successful displacement. The best corrected acuity was increased in four cases. No complication was attributed to the intravitreous injections.


CONCLUSIONS
Treatment of subretinal hemorrhage complicated age related macular degeneration by injected tPA and gas into the vitreous is a safe and efficacious method particularly for patients with anticoagulation therapy or in poor health.
Leguay
J
J
Service d'Ophtalmologie, Hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice.
Gastaud
P
P
D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D005130:Eye Hemorrhage / Q000175:diagnosis / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D005466:Fluorocarbons / Q000008:administration & dosage / Q000627:therapeutic use*; D006406:Hematoma / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008845:Microinjections; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014822:Vitreous Body
D003287:Contrast Media; D005343:Fibrinolytic Agents; D005466:Fluorocarbons; C042852:perflutren; D010959:Tissue Plasminogen Activator