Tissue plasminogen activator-assisted vitrectomy: surgical drainage of submacular hemorrhage

A thick subretinal hemorrhage involving the macula is currently treated with pneumatic displacement or surgical removal. We evaluated the long-term effects of tPA-assisted surgical drainage of a submacular hemorrhage by reviewing the medical records of 12 eyes with submacular hemorrhage followed for a mean follow-up time of 6.9 years. The final best corrected visual acuity (BCVA) improved in 10 eyes (83%), was unchanged in 2 (17%), and was reduced in 0 (0%). The mean preoperative BCVA was 6/200, and the best postoperative BCVA was 20/47, and the final BCVA was 20/143. The late postoperative complications, including recurrent submacular hemorrhage, enlargement of the CNV, and retinal degeneration, reduced the final BCVA. These results indicate that tPA-assisted surgical removal of a subretinal hemorrhage can lead to improved long-term vision. Controlling the choroidal neovascularization may be important for retaining the best postoperative vision.