title: Can intravitreal tissue plasminogen activator and SF6 gas facilitate management of macular degeneration with photodynamic therapy?
abstract: OBJECTIVE
  To describe the safety and efficacy of intravitreal tissue plasminogen activator (tPA) and sulfur hexafluoride (SF6) gas with sequential photodynamic therapy (PDT) in the management of submacular hemorrhage (SMH) associated with macular degeneration (MD).
  
  
  METHODS
  Consecutive case series of five patients presenting with acute SMH from neovascular MD between May 2004 and January 2006 in a UK Eye Centre. Duration of visual loss was less than 7 weeks. Treatment involved intravitreal injections of tPA, SF6 gas to achieve pneumatic displacement of SMH, and 24 hours prone posturing. Displacement of SMH was assessed by digital photography, and choroidal neovascularization (CNV) was reclassified using angiography. PDT was applied when indicated within 1 to 12 days postoperatively.
  
  
  RESULTS
  Adequate displacement of SMH allowed visualization of CNV within 24 hours in three of five patients. One patient with large SMH of 7 weeks duration had partial displacement of SMH. Three patients were reclassified with classic CNV after tPA-SF6 injection, and successfully underwent PDT.
  
  
  CONCLUSIONS
  Intravitreal tPA and SF6 assisted pneumatic displacement of SMH is a safe and effective intervention. This technique facilitates more accurate angiographic classification of CNV. PDT may be sequentially and rapidly applied as early as 1 day after injections. The technique may be offered to patients with neovascular MD presenting with acute SMH.
authors.affiliation: Medical Retina Service, Department of Ophthalmology, Bradford Teaching Hospitals, NHS Foundation Trust, Bradford, Yorkshire, UK. mmmk3@aol.com
authors.forename: M M K
authors.initials: MM
authors.lastname: Muqit
authors.forename: F D
authors.initials: FD
authors.lastname: Ghanchi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy*; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D000077362:Verteporfin; D014822:Vitreous Body
chemical_list: D005343:Fibrinolytic Agents; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride