Intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage secondary to retinal artery macroaneurysm.
OBJECTIVE
To assess the efficacy of treating submacular hemorrhages secondary to retinal arterial macroaneurysm with intravitreous tissue plasminogen activator (tPA) and gas.


METHODS
Six consecutive patients (6 eyes) with submacular hemorrhage secondary to retinal arterial macroaneurysm were included in this study. Tissue plasminogen activator, at a dose of 50 microg/0.1 mL, was injected through the pars plana into the vitreous cavity. Gas (0.3-0.5 mL of perfluoropropane) instillation followed tPA injection, either immediately after injection or sometime during the next day.


RESULTS
Best postoperative visual acuity improved in 5 of 6 eyes (83%) and was unchanged in 1 of 6 (17%) eyes. In 5 of 6 (83%) eyes, the procedure resulted in complete or partial displacement of submacular hemorrhage out of the foveal area.


CONCLUSIONS
Intravitreous injection of tPA and gas, followed by prone positioning of the patient, is an effective and simple treatment of submacular hemorrhage secondary to retinal arterial macroaneurysm. No complication occurred in this series.
Wu
Tsung-Tien
TT
Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China. ttwu@isca.vghks.gov.tw
Sheu
Shwu-Jiuan
SJ
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications* / Q000175:diagnosis; D003131:Combined Modality Therapy; D005260:Female; D005451:Fluorescein Angiography; D005466:Fluorocarbons / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D016684:Prone Position; D012161:Retinal Artery / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014792:Visual Acuity; D014822:Vitreous Body
D005466:Fluorocarbons; C042852:perflutren; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator