title: Management of submacular hemorrhage with intravitreal injection of tissue plasminogen activator and expansile gas.
abstract: OBJECTIVE
  To evaluate the clinical outcome of intravitreal tissue plasminogen activator (tPA) and expansile gas injection as a minimally invasive treatment for submacular hemorrhage (SMH).
  
  
  METHODS
  This study was a retrospective clinical case series examining 104 eyes that received an intravitreal injection of 30-100 mcg of tPA and expansile gas (SF6 or C3F8) for SMH. The main outcomes evaluated were visual acuities (VA), anatomic displacement of submacular blood, and surgical complications.
  
  
  RESULTS
  : A total of 85, 77, and 81 eyes were available at 1 week, 3 months, and 12 months follow up, respectively. Postoperatively, > or = 2 Snellen lines improvement were achieved in 43/85 eyes (51%) at 1 week, 49/77 eyes (63%) at 3 months, and 52/81 eyes (64%) at 12 months. Postoperative VA improvement was significantly associated with preoperative VA, submacular blood displacement, and the underlying cause of SMH. Diagnostic postoperative angiogram and clinical examination were possible at 8.2 +/- 7.4 weeks and 9.5 +/- 7.4 weeks, respectively. The observed complications included breakthrough vitreous hemorrhage in 8 eyes (8%) and retinal detachment in 3 eyes (3%).
  
  
  CONCLUSIONS
  In this retrospective series, intravitreal injection of tPA and expansile gas was shown to be a safe and effective technique that can improve VA in most eyes with SMH and assist in the diagnosis of the underlying cause.
authors: Ocular Genetics Unit, Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia. chris_chen30@hotmail.com
authors: Christine Y
authors: CY
authors: Chen
authors: Claire
authors: C
authors: Hooper
authors: Daniel
authors: D
authors: Chiu
authors: Matthew
authors: M
authors: Chamberlain
authors: Niral
authors: N
authors: Karia
authors: Wilson J
authors: WJ
authors: Heriot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005466:Fluorocarbons / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012166:Retinal Hemorrhage / Q000188:drug therapy*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
chemical_list: D005343:Fibrinolytic Agents; D005466:Fluorocarbons; C042852:perflutren; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride