title: Pneumatic displacement of submacular hemorrhage: safety, efficacy, and patient selection.
abstract: OBJECTIVE
  To investigate the safety and efficacy of pneumatic displacement of submacular hemorrhage without the use of intravitreal tissue plasminogen activator (tPA).
  
  
  METHODS
  In a prospective, consecutive, single-center, noncomparative, interventional case series, 20 consecutive patients with submacular hemorrhage due to various etiologies (duration, 1-30 days; visual acuity, hand movements to 20/125) were treated with intravitreal perfluoropropane gas injection followed by prone positioning for 5 days to 7 days. Patients were observed 1 day, 7 days, 30 days, 3 months, 6 months, and 1 year after the procedure.
  
  
  RESULTS
  Submacular blood was completely or partially displaced from the fovea in 16 of 20 eyes within 7 days after the injection. Mean best-corrected visual acuity improved from 1.6 to 0.72 logarithm of minimum angle of resolution, which was statistically significant (Wilcoxon signed rank test, P = 0.001). Final visual acuity was 20/63 or better in 10 eyes (50%). The change in proportion of eyes with best-corrected visual acuity of 20/63 or better after treatment was statistically significant (McNemar test, P = 0.002). Four patients developed nonresolving vitreous hemorrhage, which necessitated vitrectomy.
  
  
  CONCLUSIONS
  The results of pneumatic displacement of submacular hemorrhage using perfluoropropane gas are encouraging, thus questioning the role of tPA in the management of such cases.
authors: Giridhar Eye Institute, Kadavanthra, Cochin, Kerala, India. gririeye@vsnl.com
authors: Mahesh
authors: M
authors: Gopalakrishan
authors: Anantharaman
authors: A
authors: Giridhar
authors: Savita
authors: S
authors: Bhat
authors: Seshadri Jenardhanan
authors: SJ
authors: Saikumar
authors: Anna
authors: A
authors: Elias
authors: Sandhya
authors: S
authors: N
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011312:Pressure; D016684:Prone Position; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000628:therapy*; D016896:Treatment Outcome; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D005466:Fluorocarbons; C042852:perflutren