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Research Letters | June 2012

Intravitreous Tissue Plasminogen Activator With Pneumatic Displacement in Submacular Hemorrhage

Dhanashree Ratra, MS, DNB, FRCS; Amit Basia, DNB, FICO

Arch Ophthalmol. 2012;130(6):795-796. doi:10.1001/archophthalmol.2011.1856.

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Submacular hemorrhage–induced retinal damage appears to vary directly with the duration of hemorrhage. Hence, many investigators have advocated early evacuation of subretinal hemorrhage to minimize these damaging effects. In 1996, Heriot¹ presented the benefits of the minimally invasive procedure of enzymatically liquefying the submacular blood with tissue plasminogen activator (tPA) and displacing it with gas. Many studies have since shown good results with this procedure, but the exact time of the intervention is still debatable.²^- 3 Although there is no consensus, submacular bleeding for more than 28 days is generally believed to give poor results.⁴ We report a case of submacular bleeding for 60 days that showed dramatic clearing within a day with tPA and gas.

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Figure 1. A 55-year-old woman had decreased vision in her left eye for 2 months. A, Fundus photograph showed a reddish brown submacular hemorrhage with an area of altered, yellow hemorrhage. B, Indocyanine green angiography revealed a hypofluorescent area with no hot spots. The probable cause was idiopathic polypoidal choroidal vasculopathy.

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Figure 2. One day after intravitreous injection of tissue plasminogen activator (100 μg/0.1 mL) with perfluoropropane gas (0.3 mL), the unaltered submacular hemorrhage had resolved.

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Ratra D, Basia A. Intravitreous Tissue Plasminogen Activator With Pneumatic Displacement in Submacular Hemorrhage. Arch Ophthalmol. 2012;130(6):795-796. doi:10.1001/archophthalmol.2011.1856.

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