title: Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator.
abstract: OBJECTIVE
  To evaluate vitrectomy with subretinal tissue plasminogen activator (t-PA) injection, and air tamponade, followed by intravitreal anti-vascular endothelial growth factor (VEGF) therapy for submacular hemorrhage in polypoidal choroidal vasculopathy (PCV).
  
  
  METHODS
  Prospective, interventional case series.
  
  
  METHODS
  setting: Two clinics.
  
  
  METHODS
  Fifteen eyes of 15 consecutive patients (mean age 72 ± 7 years) with submacular hemorrhage attributable to PCV.
  
  
  METHODS
  PCV diagnosis with unorganized submacular hemorrhage greater than 500 μm thick.
  
  
  METHODS
  Submacular hemorrhage attributable to macular diseases (eg, high myopia, typical age-related macular degeneration, retinal angiomatous proliferation, and angioid streaks).
  
  
  METHODS
  Vitrectomy with 4000 IU t-PA injected subretinally and fluid/air exchange. Patients remained facedown for 3 days after surgery. Anti-VEGF drugs were administered as exudative changes required.
  
  
  METHODS
  Submacular hemorrhage displacement from the macula and changes in best-corrected visual acuities (BCVAs).
  
  
  RESULTS
  Mean time from onset to surgery was 9.5 ± 4.5 (range, 5-21) days. Mean follow-up period was 9.4 ± 3.1 (range, 6-17) months. Surgery successfully displaced submacular hemorrhages from the macula in all eyes. Mean BCVA at baseline (0.98 ± 0.44) had improved significantly both 1 month after surgery (0.41 ± 0.25, P < .01) and at final visits (0.23 ± 0.25, P < .001). In all eyes, exudative retinal changes relapsed after surgery but were completely resolved by anti-VEGF injections. No complications occurred in any patients.
  
  
  CONCLUSIONS
  Treating submacular hemorrhage with vitrectomy and subretinal t-PA injection, followed by intravitreal anti-VEGF therapy, is a promising strategy for improving visual acuity in PCV patients warranting further investigation.
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: shuheik@cc.okayama-u.ac.jp.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Morizane
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Mio
authors.initials: M
authors.lastname: Hosokawa
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shiode
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Kawata
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Doi
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Matoba
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Hosogi
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujiwara
authors.affiliation: Inoue Eye Clinic, Okayama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shiraga
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D020256:Choroidal Neovascularization / Q000150:complications* / Q000175:diagnosis; D004396:Coloring Agents; D003131:Combined Modality Therapy; D058450:Endotamponade; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000150:complications* / Q000175:diagnosis; D016684:Prone Position; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D020533:Angiogenesis Inhibitors; D004396:Coloring Agents; D005343:Fibrinolytic Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D010959:Tissue Plasminogen Activator; D007208:Indocyanine Green