Intravitreal Versus Subretinal Tissue Plasminogen Activator Injection for Submacular Hemorrhage

Abstract

The difference in visual acuity was not statistically significant; however, the lack of a statistical difference is important as pneumatic ± tPA is a less-invasive, less costly procedure that can be done in a clinical setting. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:26-32.].

Submacular hemorrhage secondary to age-related macular degeneration managed with vitrectomy, subretinal injection of tissue plasminogen activator, hemorrhage displacement with liquid perfluorocarbon, gas tamponade, and face-down positioning

“…To date, various surgical techniques and pneumatic methods have been investigated for manipulating the SMH and displacing it [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. Techniques consisting of vitrectomy and direct subretinal removal of the SMH have been found ineffective.…”

“…Techniques consisting of vitrectomy and direct subretinal removal of the SMH have been found ineffective. With the increasing use of tPA, pneumatic displacement techniques have become preferred methods [8], [9], [10], [11], [12], [13], [14], [15]. Vitrectomy-based methods have been preserved for large SMHs, whereas intravitreal-injection based methods were used for limited SMHs [10], [11], [12], [13], [14], [15].…”

“…In patients diagnosed with nAMD limited to one eye, neovascular lesions associated by any amount of hemorrhage were found to develop in the other eye in 19% during 4 years of follow up 6 . As visual outcomes of SMH are usually devastating, several treatment options have been evaluated for its treatment including intravitreal injection of gases and tissue plasminogen activator (tPA), vitrectomy with or without intravitreal/subretinal tPA injection and pneumatic displacement of the hemorrhage [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. A consensus on the best approach to therapy has not yet emerged 8 .…”

“…A consensus on the best approach to therapy has not yet emerged 8 . Usually small hemorrhages are managed with intravitreal anti-vascular endothelial growth factor (Anti-VEGF) and gas/tPA injections, larger and thicker hemorrhages are managed with vitrectomy, intravitreal/subretinal tPA injection and pneumatic displacement, and massive hemorrhages require subretinal surgery [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. In a multicenter randomized study, 4 patients who underwent surgery with or without tPA for hemorrhagic nAMD did not have better visual outcomes than patients who did not undergo surgery.…”

Anatomical and Functional Outcome of Pars Plana Vitrectomy and Subretinal Recombinant Tissue Plasminogen Activator for a Macular Subpigment Epithelial Haemorrhage

“…port one method over another [2][3][4] . Our case involves an 88-year-old female patient, with a previous history of bilateral neovascular age-related macular degeneration treated with bilateral intravitreal injections of aflibercept, who presented with a 4-day history of reduction of right vision.…”