title: Displacement of submacular hemorrhages in age-related macular degeneration with subretinal tissue plasminogen activator and air.
abstract: OBJECTIVE
  To study the anatomic and visual outcomes of a surgical procedure in which tissue plasminogen activator and air are injected subretinally to displace massive submacular hemorrhages secondary to age-related macular degeneration.
  
  
  METHODS
  Prospective, consecutive, interventional case series.
  
  
  METHODS
  Thirteen consecutive patients (13 eyes) with massive submacular hemorrhages secondary to age-related macular degeneration.
  
  
  METHODS
  The surgical procedure consisted of a 25-gauge vitrectomy and submacular injection of tissue plasminogen activator (25 μg) and 0.4 ml air with a microneedle having an outer diameter of 50 μm. The procedure was followed by having the patient remain in the prone position overnight.
  
  
  METHODS
  Mean visual acuity change from baseline, mean central lesion thickness change from baseline, fluorescein angiography findings, and surgical complications.
  
  
  RESULTS
  Total subfoveal blood displacement was achieved in all 13 eyes (100%). Central lesion thickness decreased from a mean baseline value of 867 μm to a mean value of 379 μm at 1 month after surgery. There was visual improvement in 11 eyes, no visual improvement in 1 eye, and poorer vision in 1 eye. The mean change in Early Treatment Diabetic Retinopathy Study letter score from baseline was 19.4 letters at 1 month (P = 0.006) and 23.3 letters at 3 months (P = 0.001). There was intraoperative macular hole formation.
  
  
  CONCLUSIONS
  Submacular air injection with a microneedle facilitates displacement of clots dissolved with tissue plasminogen activator with few complications and results in earlier visual improvement.
authors.affiliation: Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan. Electronic address: kado@med.yokohama-cu.ac.jp.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kadonosono
authors.affiliation: Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Arakawa
authors.affiliation: Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Yamane
authors.affiliation: Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yamakawa
authors.affiliation: Department of Ophthalmology, Fukuoka University, Fukuoka, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Uchio
authors.affiliation: Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yanagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D003131:Combined Modality Therapy; D058450:Endotamponade; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator