Subretinal recombinant tissue plasminogen activator injection and pneumatic displacement of thick submacular hemorrhage in Age-Related macular degeneration.
OBJECTIVE
To evaluate the anatomic and visual outcomes after a surgical procedure for displacement of thick submacular hemorrhage in patients with age-related macular degeneration.


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
Twenty-nine consecutive eyes of 28 patients with thick submacular hemorrhage secondary to age-related macular degeneration.


METHODS
The procedure consisted of a pars plana vitrectomy with subretinal recombinant tissue plasminogen activator injection (125 micrograms/ml) through a translocation microcannula, followed by fluid-air exchange and postoperative prone positioning [correction].


METHODS
Intraoperative and postoperative surgical complications, preoperative and postoperative best-corrected visual acuities, postoperative fluorescein angiography results, and additional postoperative treatments.


RESULTS
Total subfoveal blood displacement was achieved in 25 eyes, with subtotal displacement in the others. Based on fluorescein angiography results, 8 eyes were eligible for additional postoperative treatments. At 3 months, 17 eyes had gained more than 2 lines of visual acuity, whereas 3 had lost more than 2 lines. The difference between preoperative and 3-month postoperative visual acuity was statistically significant (P = 0.0167). Complications consisted of 2 cases of vitreous hemorrhage that cleared within 4 weeks.


CONCLUSIONS
This surgical technique seems useful in displacing thick submacular hemorrhage secondary to age-related macular degeneration, allowing postoperative fluorescein angiography testing and, potentially, subsequent treatments. No significant complication from the procedure was identified. However, further controlled studies will be required to assess its efficacy in the management of this difficult clinical problem.
Olivier
Sébastien
S
Retina-Vitreous Associates, Nashville, Tennessee, USA.
Chow
David R
DR
Packo
Kirk H
KH
MacCumber
Mathew W
MW
Awh
Carl C
CC
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005451:Fluorescein Angiography; D006801:Humans; D007267:Injections; D007431:Intraoperative Complications; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011312:Pressure; D016684:Prone Position; D011994:Recombinant Proteins / Q000008:administration & dosage; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014792:Visual Acuity; D014821:Vitrectomy
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator