title: Pneumatic displacement of submacular hemorrhage with or without tissue plasminogen activator.
abstract: OBJECTIVE
  To assess the efficacy and complications of intravitreal injection of sulfur hexafluoride (SF(6)) gas with/without tissue plasminogen activator (tPA) for displacing submacular hemorrhage.
  
  
  METHODS
  The medical records of 53 eyes that underwent pneumatic displacement for submacular hemorrhage were reviewed retrospectively. Submacular hemorrhage was related to exudative age-related macular degeneration (AMD) in 39 eyes and ruptured retinal arterial macroaneurysms in 14 eyes, and treated with intravitreal injection of SF(6) gas with or without tPA.
  
  
  RESULTS
  Compared with preoperatively (mean follow-up, 18.4 months), the final visual acuity (VA) improved by 0.3 or more logMAR unit in 34 eyes (64.2%), stabilized within 0.3 logMAR in 15 eyes (28.3%), and deteriorated in four eyes (7.5%). In eyes with AMD, hemorrhage including vitreous hemorrhage recurred in eight (22.2%) of 36 eyes treated with tPA and one (33.3%) of three eyes not treated with tPA. In eyes with macroaneurysms, hemorrhage recurred in four (100%) of four eyes treated with tPA and in one (10.0%) of ten eyes without tPA (p < 0.005). Eight eyes underwent vitrectomy for recurrent hemorrhage. During follow-up, photodynamic therapy or intravitreal ranibizumab or pegaptanib was administered in 16 (41.0%) of 39 eyes with AMD. Postoperative ocular hypertension persisting over 3 days was not observed.
  
  
  CONCLUSIONS
  Intravitreal SF(6) gas plus tPA may be well-accepted, with good visual outcomes and no remarkable complications for treating submacular hemorrhage secondary to AMD. tPA is not recommended for ruptured retinal arterial macroaneurysms, because of a higher incidence of subsequent vitreous hemorrhage. Pneumatic displacement of submacular hemorrhage without tPA may provide good visual outcomes with less re-bleeding.
authors: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya-shi, Aichi 467-8601, Japan.
authors: Takeshi
authors: T
authors: Mizutani
authors: Tsutomu
authors: T
authors: Yasukawa
authors: Yuya
authors: Y
authors: Ito
authors: Ayae
authors: A
authors: Takase
authors: Yoshio
authors: Y
authors: Hirano
authors: Munenori
authors: M
authors: Yoshida
authors: Yuichiro
authors: Y
authors: Ogura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008266:Macula Lutea; D008268:Macular Degeneration / Q000150:complications; D008875:Middle Aged; D010778:Photochemotherapy; D016684:Prone Position; D012008:Recurrence; D012161:Retinal Artery / Q000473:pathology; D012164:Retinal Diseases / Q000150:complications; D012166:Retinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628: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
chemical_list: D020533:Angiogenesis Inhibitors; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride