Pneumatic displacement of acute submacular hemorrhage with and without the use of tissue plasminogen activator.
OBJECTIVE
To evaluate the efficacy of C(3)F(8) gas-assisted pneumatic displacement in the treatment of massive submacular hemorrhage, with and without the use of tissue plasminogen activator (tPA).


METHODS
Twenty-one eyes of 21 patients with recently developed (up to 10 days) dense submacular hemorrhage underwent intravitreal injection of pure C(3)F(8) gas (0.4-0.5 mL) followed by face-down positioning for pneumatic displacement. Seven of them received additional intravitreal injection of 25-50 microg tPA. The primary etiology of submacular hemorrhage was age-related macular degeneration (n=16), myopic choroidal neovascularization (n=2), retinal arterial macroaneurysm (n=2), and trauma (n=1). Visual acuity and displacement of hemorrhage were the main outcome measures.


RESULTS
Follow-up period was 6-12 months. Effective displacement of hemorrhage was obtained in 20 of 21 patients within 7 days. Final median Snellen visual acuity (0.18) was found significantly improved compared to baseline (0.03) (p<0.001). Visual acuity improvement was similar in both groups (p=0.72).


CONCLUSIONS
Intravitreal injection of C(3)F(8) effectively displaced thick submacular hemorrhage and improved visual acuity independently from primary cause. Additional tPA use in this study had no impact on the final outcomes.
Cakir
Mehmet
M
Beyoglu Eye Training and Research Hospital, Istanbul - Turkey. drmcakir@hotmail.com
Cekiç
Osman
O
Yilmaz
Omer F
OF
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D005466:Fluorocarbons / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011312:Pressure; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
D005343:Fibrinolytic Agents; D005466:Fluorocarbons; C042852:perflutren; D010959:Tissue Plasminogen Activator