Surgical Removal of Submacular Hemorrhage Using Tissue Plasminogen Activator and Perfluorocarbon Liquid

• Published in: American journal of ophthalmology Vol. 121; no. 3; pp. 267 - 275
• Main Authors: KAMEI, MOTOHIRO, TANO, YASUO, MAENO, TAKATOSHI, IKUNO, YASUSHI, MITSUDA, HISATOSHI, YUASA, TAKENOSUKE
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-1996; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Female; Fluorocarbons - therapeutic use; Follow-Up Studies; Fundus Oculi; Humans; Macula Lutea - surgery; Macular Degeneration - complications; Male; Medical sciences; Middle Aged; Plasminogen Activators - therapeutic use; Recurrence; Retinal Hemorrhage - etiology; Retinal Hemorrhage - pathology; Retinal Hemorrhage - therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Thrombolytic Therapy; Tissue Plasminogen Activator - therapeutic use; Visual Acuity; Vitrectomy; Human; Retinopathy; Serine endopeptidases; Enzyme; Organic perhalocompound; Surgical drainage; Cardiovascular disease; Retina; Fluorocarbon; Injection; Hemorrhage; t-Plasminogen activator; Vascular disease; Macula; Eye disease; Treatment; Subretinal fluid; Surgery; Hydrolases; Degeneration; Proteinases; Age; Fibrinolytic
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(14)70274-0

To assess the result of surgical removal of submacular hemorrhage by using tissue plasminogen activator and perfluorocarbon liquid.
In 22 consecutive patients (22 eyes), subretinal hemorrhage associated with age-related macular degeneration, which involved the fovea and completely obscured the choroidal vascular pattern, was treated by pars plana vitrectomy. The hemorrhages were liquefied with tissue plasminogen activator, squeezed into the vitreous cavity with perfluorocarbon liquid, and then evacuated.
Efficacy of the procedure was judged by the best postoperative corrected visual acuity, which was 20/100 or better in 16 eyes (73%). Submacular hemorrhage recurred in four (18%) eyes, epiretinal membrane formed in three (14%) eyes, and retinal detachment occurred in three (14%) eyes. Best-corrected final visual acuity was improved postoperatively in 18 (82%) of the 22 eyes, unchanged in three (14%) eyes, and decreased in one (5%) eye. Final visual acuity was 20/200 or better in 15 eyes (68%) and limited in other eyes by subretinal hemorrhage of greater than 30 days' duration or subfoveal neovascularizations.
Use of tissue plasminogen activator and perfluorocarbon liquid in surgical removal of submacular hemorrhage may improve the outcome of surgery by reducing surgically induced retinal damage.