title: Management of Acute Submacular Hemorrhage with Intravitreal Injection of Tenecteplase, Anti-vascular Endothelial Growth Factor and Gas.
abstract: OBJECTIVE
  To evaluate the visual and anatomical outcomes for neovascular age-related macular degeneration with submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelial growth factor (VEGF) and expansile gas.
  
  
  METHODS
  This study was a retrospective clinical case series following 25 eyes of 25 patients. All patients received a triple injection using 0.05 mL TNK (50 µg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visual acuity and central retinal thickness were analyzed.
  
  
  RESULTS
  The mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantly from 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thickness also improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visual improvement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied.
  
  
  CONCLUSIONS
  A triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration.
authors.affiliation: Retina Center, Nune Eye Hospital, Seoul, Korea.
authors.forename: Jung Pil
authors.initials: JP
authors.lastname: Lee
authors.affiliation: Retina Center, Nune Eye Hospital, Seoul, Korea.
authors.forename: Jun Sang
authors.initials: JS
authors.lastname: Park
authors.affiliation: Retina Center, Nune Eye Hospital, Seoul, Korea.
authors.forename: Oh Woong
authors.initials: OW
authors.lastname: Kwon
authors.affiliation: Retina Center, Nune Eye Hospital, Seoul, Korea.
authors.forename: Yong Sung
authors.initials: YS
authors.lastname: You
authors.affiliation: Retina Center, Nune Eye Hospital, Seoul, Korea.
authors.forename: Soon Hyun
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005451:Fluorescein Angiography; D005466:Fluorocarbons / Q000008:administration & dosage*; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D000077785:Tenecteplase; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D005343:Fibrinolytic Agents; D005466:Fluorocarbons; D042461:Vascular Endothelial Growth Factor A; C042852:perflutren; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase
keywords: Anti-vascular endothelial growth factor; Expansile gas; Intravitreal injection; Submacular hemorrhage; Tenecteplase