Tissue plasminogen activator in the surgical management of subretinal haemorrhage

We report three cases of the use of tissue plasminogen activator (TPA) to aid the surgical removal of subretinal haemorrhage. All patients had choroidal neovascular membranes secondary to age-related macular degeneration. The technique involved infusing a sterile solution of TPA through a small retinotomy and irrigating out the dissolved clot. The visual acuity improved in the first patient from a preoperative 6/36 to 6/18 five weeks after surgery, but subsequently deteriorated to 6/60 after six months from a new choroidal neovascular membrane (CNVM), remaining 6/60 at nine months after surgery. The second patient's visual acuity improved from count fingers to 6/24 three weeks after surgery, but subsequently deteriorated to 6/60 after four months from a new CNVM, remaining 6/60 at nine months after surgery. The third patient's visual acuity improved from count fingers to 6/36 and remains stable at 6/36, eight months after surgery. Although long-term prognosis remains guarded, these early results suggest that TPA may have a role in the management of subretinal haemorrhage.