Tissue plasminogen activator irrigation to facilitate removal of subretinal hemorrhage during vitrectomy

I report removing a large submacular hemorrhage by means of vitrectomy combined with use of tissue plasminogen activator (tPA) to facilitate clot removal. Four months postoperatively, the vision was 20/100 and the retina was flat, with a very thin layer of residual hemorrhage and pigmentary alteration in the macula. Although the long-term prognosis is guarded, this case does suggest that tPA may be a useful adjunct in managing selected cases of subretinal hemorrhage associated with macular degeneration.