title: Successful displacement of a traumatic submacular hemorrhage in a 13-year-old boy treated by vitrectomy, subretinal injection of tissue plasminogen activator and intravitreal air tamponade: a case report.
abstract: BACKGROUND
  The natural course of submacular hemorrhage resulting from traumatic choroidal rupture generally has a poor outcome unless treated. The intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) has been reported to be effective, but has also been reported to induce severe complications such as retinal detachment and vitreous hemorrhage. Recently, we reported a safe and effective procedure for treating submacular hemorrhage due to polypoidal choroidal vasculopathy (PCV) with a low dose of rt-PA. Here we report the application of this procedure to a case of traumatic submacular hemorrhage in a 13-year-old boy, which achieved a good visual outcome.
  
  
  METHODS
  A 13-year-old Japanese boy presented with a thick submacular hemorrhage in his left eye as a result of blunt trauma from being hit by a sinker. Best-corrected visual acuity (BCVA) was assessed as only able to perceive hand motions. We carried out a vitrectomy, subretinal injection of 4,000 IU rt-PA (6.9 μg) and air tamponade. The day after surgery, most of the submacular hemorrhage had moved to the inferior periphery. One month after the surgery, we observed cataract formation, thin remnants of the submacular hemorrhage and juxtafoveal choroidal rupture. We carried out cataract surgery and injected bevacizumab intravitreally to prevent the development of choroidal neovascularization. Two months after the second surgery, the submacular hemorrhage had totally disappeared and the patient had a BCVA of 20/40.
  
  
  CONCLUSIONS
  Vitrectomy, subretinal injection of rt-PA, and intravitreal air tamponade may be a promising strategy for treating traumatic submacular hemorrhage in young patients.
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. shin-d@okayama-u.ac.jp.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Doi
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. 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, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. moriza-y@okayama-u.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Morizane
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. shiode2001@yahoo.co.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shiode
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. hmo529@okayama-u.ac.jp.
authors.forename: Mio
authors.initials: M
authors.lastname: Hosokawa
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. p6fb9zzp@s.okayama-u.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hirano
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. mika.hosogi.0823@gmail.com.
authors.forename: Mika
authors.initials: M
authors.lastname: Hosogi
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. atsushi@okayama-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujiwara
authors.affiliation: Department of Ophthalmology, Sumitomo-Bessi Hospital, Niihama, Japan. miyamo1234@yahoo.co.jp.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Miyamoto
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan. fumio327@symphony.plala.or.jp.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shiraga
mesh_terms: D000293:Adolescent; D000388:Air; D003131:Combined Modality Therapy; D058450:Endotamponade; D005131:Eye Injuries / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D056965:Injections, Intraocular; D008297:Male; D012160:Retina / Q000293:injuries*; D012166:Retinal Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014949:Wounds, Nonpenetrating / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator