title: Recombinant tissue plasminogen activator, vitrectomy, and gas for recent submacular hemorrhage displacement due to retinal macroaneurysm.
abstract: BACKGROUND
  The visual prognosis of submacular hemorrhages caused by a retinal arterial macroaneurysm (RAM) is poor if left untreated. The use of recombinant tissue plasminogen activator (rtPA) has frequently been reported to displace submacular hemorrhages from the foveal area in patients with age-related macular degeneration. This study aims to investigate the results of displacement of recent-onset submacular hemorrhages due to RAM.
  
  
  METHODS
  Institutional retrospective interventional case series of 12 patients with macular hemorrhage due to RAM, who underwent pars plana vitrectomy (PPV); followed in 11 by submacular injection of rtPA and gas tamponade. The main outcome measures were displacement of the hemorrhage, complication rate, and visual acuity at 1 month after surgery and at the last follow-up visit.
  
  
  RESULTS
  One month after surgery, the hemorrhage had been successfully displaced in ten out of 11 patients. In these ten patients, visual acuity (VA) increased by a mean of 1.2 logMAR at 1 month after surgery. At the last follow-up visit, the mean increase was 1.5 logMAR. Complications consisted of a vitreous hemorrhage and hyphema, retinal detachment, a new submacular hemorrhage, and vitreous hemorrhage after argon laser retinal photocoagulation of the RAM.
  
  
  CONCLUSIONS
  PPV with submacular rtPA and gas injection may successfully displace a recently developed submacular hemorrhage in patients with RAM, with a marked improvement in VA that is likely to be greater than if left untreated.
authors.affiliation: The Rotterdam Ophthalmic Institute, Schiedamse Vest 160-D, 3011 BH Rotterdam, The Netherlands. e.vanzeeburg@oogziekenhuis.nl
authors.forename: Elsbeth J T
authors.initials: EJ
authors.lastname: van Zeeburg
authors.forename: Matteo G
authors.initials: MG
authors.lastname: Cereda
authors.forename: Jan C
authors.initials: JC
authors.lastname: van Meurs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications*; D003131:Combined Modality Therapy; D058450:Endotamponade; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011187:Posture; D011994:Recombinant Proteins / Q000627:therapeutic use; D012166:Retinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012171:Retinal Vessels; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride