Initial clinical experience with tissue plasminogen activator (tPA) assisted removal of submacular haemorrhage

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Abstract

Tissue plasminogen activator (tPA) (250 μ/ml) was used to facilitate removal of submacular thrombus in 15 patients. Following a three-port vitrectomy and subretinal tPA injection (0.1 ml) via a 30 gauge needle, blood was evacuated after enzymatic dissolution for 20 minutes. Two injections were required in some cases. Nine women and six men were treated (mean age 75.5 ± 8.6 years). Duration of symptoms ranged from 2 days to 8 weeks. One case was due to a retinal macroaneurysm, the others to age-related macular degeneration. Vision improved in 13 patients and remained the same or deteriorated in 2 (mean follow-up 11, ± 4.9 months). Well-defined subretinal neovascular membranes were identified in 2 patients and occult neovascularisation suspected in 2 others. A cataract developed in 1 case and retinal detachments in 2 others; all were treated successfully. The poor visual prognosis associated with submacular haemorrhage may be obviated by the use of the technique we describe.

References

  1. 1

    Bennett SR, Folk JC, Blodi CF, Klugman M . Factors prognostic of visual outcome in patients with subretinal haemorrhage. Am J Ophthalmol 1990;109:33.

  2. 2

    Glatt H, Machemer R . Experimental subretinal haemorrhage in rabbits. Am J Ophthalmol 1982;94:762.

  3. 3

    Vander JF, Federman JL, Greven C, et al. Surgical removal of massive subretinal haemorrhage associated with age related macular degeneration. Ophthalmology 1991;98:23–7.

  4. 4

    Toth CA, Morse LS, Hjelmeland LM, et al. Fibrin directs early retinal damage after experimental subretinal haemorrhage. Arch Ophthalmol 1991;109:723–9.

  5. 5

    Johnson MW, Olsen KR, Hernandez E . Tissue plasminogen activator thrombolysis during surgical evacuation of experimental subretinal haemorrhage. Ophthalmology 1992;99:515–21.

  6. 6

    Lewis H, Resnick SC, Flannery JG, Straatsma BR . Tissue plasminogen activator treatment of experimental subretinal haemorrhage. Am J Ophthalmol 1991;111:197–204.

  7. 7

    Toth CA, Benner JD, Hjelmeland LM, et al. Ultra-microsurgical removal of subretinal haemorrhage in cats. Am J Ophthalmol 1992;113:175–82.

  8. 8

    Peyman GA, Nelson NC, Altukri W, et al. Tissue plasminogen activating factor assisted removal of subretinal haemorrhage. Ophthalmic Surg 1991;22:575–82.

  9. 9

    Vander JF . Tissue plasminogen activator irrigation to facilitate removal of subretinal haemorrhage during vitrectomy. Ophthalmic Surg 1992;23:361–3.

  10. 10

    Gilles A, Lahav M . Absorption of retinal and subretinal haemorrhages. Ann Ophthalmol 1983;15:1068.

  11. 11

    Collen D, Stussen JM, Marafino BJ Jr, et al. Biological properties of human tissue-type plasminogen activator obtained by expression of recombinant DNA in mammalian cells. J Pharmacol Exp Ther 1984;231:146–52.

  12. 12

    Pennica D, Holmes WE, Kohr WJ, et al. Cloning and expression of human tissue-type plasminogen activator cDNA in E. coli Nature 1983;301:214–21.

  13. 13

    Williams GA, Lambrou FH, Jaffe GJ, et al. Treatment of post-vitrectomy fibrin formation with intraocular tissue plasminogen activator. Arch Ophthalmol 1988;106:1055–8.

  14. 14

    Oncel M, Peyman GA, Koobebi B . Tissue plasminogen activator in the treatment of experimental retinal vein occlusion. Retina 1989;9:1.

  15. 15

    Vine AK, Maguire PT, Martoryi C, Kincaid MC . Recombinant tissue plasminogen activator to lyse experimentally induced retinal arterial thrombi. Am J Ophthalmol 1988;105:266.

  16. 16

    Lambrou FH, Snyder RW, Williams GA . Use of tissue plasminogen activator in experimental hyphaema. Arch Ophthalmol 1987;105:995–7.

  17. 17

    Sternberg P Jr, Aguilar HE, Drews C, et al. The effect of tissue plasminogen activator on retinal bleeding. Arch Ophthalmol 1990;108:720–2.

  18. 18

    Destro M, Puliafito CA . Indocyanine green videoan-giography of choroidal neovascularisation. Ophthalmology 1989;96:846–53.

  19. 19

    Balles MW, Puliafito CA, Kliman GH, et al. Indocyanine green dye enhanced diode laser photocoagulation of subretinal neovascular membranes. Invest Ophthalmol Vis Sci 1990;31(ARVO Suppl):282.

  20. 20

    Avery RL, Hickingbotham D, Jaffe G, De Juan E . Intraoperative fluorescein angioscopy in subretinal surgery [letter]. Arch Ophthalmol 1992;110:1518–9.

  21. 21

    Johnson RN, Olsen KR, Hernandez E . Intravitreal tissue plasminogen activator treatment of experimental vitreous haemorrhage. Arch Ophthalmol 1989;107:891–4.

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Correspondence to Anthony P Moriarty.

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