J Korean Ophthalmol Soc.  2008 Feb;49(2):267-273. 10.3341/jkos.2008.49.2.267.

Intravitreal Injection of tPA and Gas for Submacular Hemorrhage Associated with Age-related Macular Degeneration

• Kim JH
• Son JH
• Chang WH

• KMID: 2127118
• DOI: http://doi.org/10.3341/jkos.2008.49.2.267

Abstract

PURPOSE: To study the results of intravitreal tissue plasminogen activator (tPA) and expansile gas injection for the treatment of submacular hemorrhage in age-related macular degeneration (AMD).
METHODS
Eleven consecutive patients (11 eyes) with submacular hemorrhage in AMD were included in this study. All patients were treated with intravitreal injections of tPA and C3F8 gas. Postoperatively, patients' follow-up period were at least 3 months. Outcome measures included early and final visual acuity, age, disc areas of hemorrhage, duration of symptoms, displacement of blood from the fovea, and final macular status.
RESULTS
The maximum diameter of the hematoma ranged from 2 to 10 disc diameters. The mean duration of submacular hemorrhage was 7.5 days. Submacular blood was completely displaced in 7 patients (64%) and partially in four (36%). Best postoperative visual acuity improved in 7 eyes; in 6 eyes (55%), the improvement was two or more lines. Final visual acuity improved in 7 eyes (64%), remained stable in 2 eyes (18%), and worsened in 2 eyes (18%). Choroidal neovascularization positioned at subfovea in 7 eyes (64%) and juxtafovea in 4 eyes (36%). No significant difference was found between postoperative visual recovery and these factors.
CONCLUSIONS
Our findings suggest that intravitreal tPA and expansile gas injection are safe and of useful for displacing hemorrhages secondary to age-related macular degeneration. Final visual acuity was limited by the underlying choroidal neovascularization of AMD.

Keyword

Age-related macular degeneration; Submacular hemorrhage; Tissue plasminogen activator

MeSH Terms

Choroidal Neovascularization
Displacement (Psychology)
Eye
Follow-Up Studies
Hematoma
Hemorrhage
Humans
Intravitreal Injections
Macular Degeneration
Outcome Assessment (Health Care)
Tissue Plasminogen Activator
Visual Acuity
Tissue Plasminogen Activator

Figure

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  Figure 1. Fundus photograph of Patient 2 (66/M) (A) Preoperative fundus photograph shows wide blood clot covering the fovea.(B) 4-week postoperative fundus photograph demonstrates typical displacement of blood inferotemporal to the fovea.

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  Figure 2. Fundus photograph of Patient 5 (67/M) (A) Submacular hemorrhage involving the fovea center shown before surgery. (B) Corresponding preoperative fluorescein angiogram. (C) Submacular hemorrhage completely displaced from the fovea 2 weeks after surgery. (D) Corresponding postoperative fluorescein angiogram showing juxtafoveal choroidal neovascular membrane.

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  Figure 3. Initial visual acuity versus final visual acuity. Eyes experiencing visual improvement fall above the oblique line.

Reference

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