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.
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Ophthalmic Surgery, Lasers and Imaging Retina (2017)
Submacular hemorrhage in neovascular age-related macular degeneration: A synthesis of the literature
Survey of Ophthalmology (2016)
Hemorrhagic Age-Related Macular Degeneration Managed With Vitrectomy, Subretinal Injection of Tissue Plasminogen Activator, Gas Tamponade, and Upright Positioning
Ophthalmic Surgery, Lasers and Imaging Retina (2013)
INTRAVITREAL TISSUE PLASMINOGEN ACTIVATOR, PERFLUOROPROPANE (C3F8), AND RANIBIZUMAB OR PHOTODYNAMIC THERAPY FOR SUBMACULAR HEMORRHAGE SECONDARY TO WET AGE-RELATED MACULAR DEGENERATION