Pneumatic displacement of a dense submacular hemorrhage with or without tissue plasminogen activator

To evaluate the efficacy of treating a dense submacular hemorrhage with pneumatic displacement with or without tissue plasminogen activator (tPA).

Twenty-four patients with a dense submacular hemorrhage were treated with intravitreal expansile gas, with or without an intravitreal injection of tPA, in order to displace the submacular blood. The main outcome measurements include preoperative and postoperative visual acuity, postoperative fluorescein angiography (FAG) results and additional postoperative treatments.

Total or subtotal subfoveal blood displacement was achieved in all 24 eyes. After a mean follow-up of 15.5 months (range 6-50 months), final visual acuity had improved two or more lines in 11 (45.8%) of the 24 eyes, and measured 20/100 or better in 10 (41.7%) of the 11 eyes. Based on the FAG results for 14 cases, nine eyes (64.3%) received additional postoperative laser treatment. Final visual acuity of 20/100 or better was achieved in four (40%) of the 10 eyes, with a choroidal neovascular membrane (CNVM) detected on FAG, and dye leakage not detected in three (75%) of the four eyes.

Pneumatic displacement, with or without intravitreal injection of tPA, seems useful in displacing dense submacular hemorrhage and facilitating visual improvement, although the visual result is often limited by the progression of the underlying macular disease. In patients with age-related macular degeneration, more treatable CNVM may be detected on postoperative FAG.