title: Vitrectomy and subretinal injection of tissue plasminogen activator for large submacular hemorrhage secondary to AMD.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of pars plana vitrectomy (PPV) with subretinal injection of tissue plasminogen activator (tPA) for the treatment of large submacular hemorrhage (SMH) secondary to age-related macular degeneration (AMD), and identify parameters correlated with the visual prognosis.
  
  
  METHODS
  Thirty-one eyes that underwent PPV with subretinal tPA injection for large SMH secondary to AMD were included in this retrospective study. Main outcome measure was improvement in at least one line in visual acuity (VA).
  
  
  RESULTS
  Improvement in VA was achieved in 14 (45.2%) patients. These patients had a significantly worse VA at presentation than patients who did not improve (p = 0.05). Central retinal thickness and earlier intervention were not correlated with the final visual prognosis. Postoperative complications included retinal detachment (19.3%), recurrent SMH (6.4%), and elevated intraocular pressure (6.4%).
  
  
  CONCLUSIONS
  The VA at presentation is the most significant preoperative parameter associated with improvement in VA. A cutoff value of counting fingers VA is suggested, as patients with better VA at presentation did not benefit from surgery.
authors: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel.
authors: Elad
authors: E
authors: Moisseiev
authors: Tal
authors: T
authors: Ben Ami
authors: Adiel
authors: A
authors: Barak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D056965:Injections, Intraocular; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D008297:Male; D011183:Postoperative Complications; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator