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SUBRETINAL TISSUE PLASMINOGEN ACTIVATOR WITHOUT VITRECTOMY FOR SUBMACULAR HEMORRHAGE DISPLACEMENT USING
Vivian W K Hui1,2, Chi Wai Tsang1,2, Shaheeda Mohamed1,2
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
Purpose:
To evaluate the surgical outcome of subretinal tissue plasminogen activator delivered without vitrectomy for the displacement of submacular hemorrhage.
Methods:
A retrospective interventional case series of consecutive patients who underwent subretinal tissue plasminogen activator and intravitreal expansile gas without vitrectomy for submacular hemorrhage displacement. Concomitant injection of subretinal air and intravitreal ranibizumab and expansile gas was performed per surgeon's discretion.
Results:
Seven eyes from seven patients were included. Six eyes (85.7%) had polypoidal choroidal vasculopathy and one eye (14.3%) had wet age-related macular degeneration. The median baseline visual acuity was 0.014 (range 0.005-50.1) Early Treatment Diabetic Retinopathy Study letters, which improved to 35 (range 26.3-65.1), 35 (range 31.0-73.9), 35 (range 35-77.3), and 35 (range 5-80.2), Early Treatment Diabetic Retinopathy Study letters at 1 week, 1 month, 3 months, and 6 months, respectively. Visual gain of ≥5 letters was achieved in most patients through 6 months. Successful displacement of blood away from fovea was achieved in 100% of eyes. The rate of postoperative vitreous hemorrhage, retinal pigment epithelium tear, and macular hole was 14.3% (one patient) each.
Conclusion:
This novel, minimally invasive surgical technique is effective in displacing submacular hemorrhage and preserving vision.
