title: Long-term visual outcome and its predictive factors following treatment of acute submacular hemorrhage with intravitreous injection of tissue plasminogen factor and gas.
abstract: OBJECTIVE
  To investigate the long-term functional outcome and its predictive factors of treatment of acute submacular hemorrhage secondary to age-related macular degeneration with intravitreal application of recombinant tissue plasminogen activator (rt-PA) and gas.
  
  
  METHODS
  Twenty-six patients were enrolled in the retrospective case series. A complete history and ocular examination, including fluorescein angiography, were performed. The best-corrected visual acuity was measured with a Snellen chart. Patients were followed up for 12 to 131 months (mean: 49 months). All patients underwent intravitreal injection of rt-PA (50 μg) and expansile gas. Primary outcome measures were best postoperative and final visual acuity and degree of blood displacement.
  
  
  RESULTS
  The size of the subretinal hemorrhage ranged from 0.5 to 28 disc diameters, and the degree of blood displacement was defined as complete (≥1 disc area from the center of the fovea), partial, or no displacement. Twenty-one (81%) patients showed partial or complete displacement of hemorrhage. Due to lack of displacement of hemorrhage in 5 patients (19%), submacular surgery was performed. In 13 of 21 (62%; P=0.0001) patients with displacement of hemorrhage, the best postoperative visual acuity improved ≥2 lines. The final visual acuity improved ≥2 lines in 42.9% (9 of 21), was stable in 23.8% (5 of 21), and worse ≥2 lines in 33.3% (7 of 21) of patients. The short duration of hemorrhage (≤4 days) and complete displacement of blood, independent of the hemorrhage size, were significantly associated with better postoperative visual acuity (P=0.0001, P=0.0001, respectively).
  
  
  CONCLUSIONS
  Intravitreal injection of rt-PA and gas seem to be more effective when applied within the first 4 days of acute submacular hemorrhage. Preoperative visual acuity as well as displacement of hemorrhage might be useful to predict final visual acuity.
authors.affiliation: 1 Centre for Ophthalmology, Eberhard-Karls University Tuebingen , Tuebingen, Germany .
authors.forename: Bianka
authors.initials: B
authors.lastname: Sobolewska
authors.forename: Eray
authors.initials: E
authors.lastname: Utebey
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.forename: Olcay
authors.initials: O
authors.lastname: Tatar
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005740:Gases / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012166:Retinal Hemorrhage / Q000188:drug therapy*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005740:Gases; D010959:Tissue Plasminogen Activator