title: Intravitreal injection of recombinant tissue plasminogen activator in submacular hemorrhage: case series.
abstract: OBJECTIVE
  To report the safety and efficacy of intravitreal recombinant tissue plasminogen activator (rtPA) with gas for managing submacular hemorrhage.
  
  
  METHODS
  Patients with submacular hemorrhage centered in or close to the fovea underwent hemorrhage displacement with intravitreal injection of rtPA (50 μg/0.05 mL) followed by gas injection (0.3 mL SF6). Anatomic and visual outcomes are described.
  
  
  RESULTS
  Exudative age-related macular degeneration (AMD) (n = 4) and blunt trauma (n = 2) were the etiologies of submacular hemorrhage in this sample. Intravitreal injection of rtPA decreased the extent of submacular hemorrhage in all eyes, with complete hemorrhage displacement in 2 and partial displacement in 4. Visual acuity remained stable (n = 4) or improved (n = 2) after the procedure. Improvements in anatomic and visual outcomes were less evident in exudative AMD cases, which also had longer hemorrhage duration. Recurrence occurred only in 1 eye. No evident rtPA-associated retinal toxicity was observed.
  
  
  CONCLUSIONS
  Untreated submacular hemorrhage has poor visual prognosis. Our results suggest that rtPA injection is a minimally invasive, simple, inexpensive procedure with few related complications. Cost-benefit of this injection seems acceptable.
authors.affiliation: Ophthalmology Department, S. João Hospital, Porto - Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Araújo
authors.affiliation: Ophthalmology Department, S. João Hospital, Porto - Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sousa
authors.affiliation: Ophthalmology Department, S. João Hospital, Porto - Portugal.|Department of Sense Organs, University of Porto, Porto - Portugal.
authors.forename: Pedro Alves
authors.initials: PA
authors.lastname: Faria
authors.affiliation: Ophthalmology Department, S. João Hospital, Porto - Portugal.|Department of Sense Organs, University of Porto, Porto - Portugal.
authors.forename: Ângela
authors.initials: Â
authors.lastname: Carneiro
authors.affiliation: Ophthalmology Department, S. João Hospital, Porto - Portugal.|Department of Sense Organs, University of Porto, Porto - Portugal.
authors.forename: Amândio
authors.initials: A
authors.lastname: Rocha-Sousa
authors.affiliation: Ophthalmology Department, S. João Hospital, Porto - Portugal.|Department of Sense Organs, University of Porto, Porto - Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Falcão-Reis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D058450:Endotamponade; D005131:Eye Injuries / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012166:Retinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000150:complications; D014949:Wounds, Nonpenetrating / Q000150:complications
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride