Vitrectomy with Low-Dose Subretinal t-PA for Hemorrhage Due to Traumatic Choroidal Rupture: A Case Series

Choroidal rupture with subretinal hemorrhage comprising the fovea is thought to have poor prognosis regardless of surgical interventions. Being a relatively rare entity, managing patients, referring them in time and standardizing a therapeutic approach remains challenging. Many eyecare practitioners opt solely for conservative treatment, without recurring to any surgical treatment.

Three young adult males with blunt ocular trauma complicated by choroidal rupture with subretinal hemorrhage presented to the vitreoretinal surgeon appointment. All of them underwent pars plana vitrectomy with subretinal rtPA administration. All patients were then monitored for recovery with conservative treatment and despite the present post traumatic choroidal rupture, they achieved major improvement in visual acuity along with OCT parameters compared to their initial presentation.

Not all vitreoretinal surgeons perform subretinal rtPA injection, partly due to not being trained in this aspect, but also due to controversies around this approach. Intravitreal rtPA injection is an easier alternative, although less impactful. Sometimes, even performing a gas endotamponade in the vitreous cavity without specific fibrinolytic treatment can improve results upon blood dislocation away from the fovea. Knowledge on the possibility of surgical intervention in patients with subretinal hemorrhage is important to be popularized among ophthalmologists, so they can refer these cases to vitreoretinal surgeons promptly instead of sticking to conservative treatment only, which may be the inferior choice in cases with macular involvement when time plays a key role.