Intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage

We sought to evaluate the efficacy, safety, and visual outcome of intravitreal tissue plasminogen activator (t-pa) and pneumatic displacement to treat submacular hemorrhage.

In this retrospective, interventional case series, 46 consecutive eyes of 45 patients received intravitreal t-pa (50µg in 0.1 mL) and expansile gas (0.3 mL perfluoropropane) injection for submacular hemorrhage. Hemorrhages were secondary to exudative age-related macular degeneration in 28 eyes, idiopathic polypoidal choroidal vasculopathy (IPCV) in 11 eyes, retinal arterial macroaneurysm in 2 eyes, pathologic myopia in 3 eyes, and trauma in 1 eye. After surgery, patients maintained a supine position for the first 6 h and then remained prone for about 1 week. Outcome measures were visual acuity, displacement of submacular hemorrhage, and surgical complications.

Complete displacement of thick blood out of the fovea was achieved in 40 of 45 eyes (89%), and partial displacement was achieved in 5 eyes (11%). Best postoperative visual acuity improved by 2 Snellen lines or greater in 21 of 45 eyes (46.67%). At a mean follow up of 15.64 months, final visual acuity improved by 2 Snellen lines or greater in 16 eyes (35.6%). The complication of breakthrough vitreous hemorrhage occurred in nine eyes (20%). Eyes with nonage-related macular degeneration tended to have better final visual recovery, especially eyes with IPCV over extended follow up (P = 0.035).

Intravitreal injection of t-pa and expansile gas was an effective and safe treatment for submacular hemorrhage. Our study features a considerable number of patients with IPCV, and the outcomes are favorable.