Submacular Hemorrhage in Polypoidal Choroidal Vasculopathy Treated by Vitrectomy and Subretinal Tissue Plasminogen Activator

Successful displacement of a traumatic submacular hemorrhage in a 13-year-old boy treated by vitrectomy, subretinal injection of tissue plasminogen activator and intravitreal air tamponade: a case report

“…Two days after the initial visit, we carried out anterior chamber lavage, vitrectomy, subretinal injection of rt-PA (GRTPA®, Mitsubishi Tanabe Pharma Corporation, Japan) and air tamponade on the left eye under general anesthesia. This operation was performed using the methods reported by Kimura et al [ 8 ]. Briefly, after performing a 25-gauge micro-incision vitrectomy, 4,000 IU rt-PA in 0.1 ml was injected subretinally using a 38-gauge subretinal infusion needle (MedOne, Sarasota, FL) to liquefy the submacular hemorrhage.…”

“…To date, traumatic submacular hemorrhage was often treated with the intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) without carrying out a vitrectomy [ 4 – 7 ]. However, injecting gas into non-vitrectomized eyes has been reported to induce severe complications, such as retinal detachment and vitreous hemorrhage [ 4 , 8 ].…”

“…Recently, we have reported that vitrectomy, subretinal injection of rt-PA and air tamponade were effective in treating submacular hemorrhage due to PCV [ 8 ]. This procedure assured the safe displacement of submacular hemorrhages, using a low dose of rt-PA. We therefore applied the same procedure to a traumatic submacular hemorrhage in a 13-year-old boy and achieved a good visual outcome.…”

Intraocular Pharmacokinetics and Safety of Subretinal Injection Compared with Intravitreal Application of Conbercept in Vitrectomized Rabbit Eyes

“…After removing the blood clot, the postoperative visual outcome mainly depends on the extent of the underlying choroidal neovascularization (CNV) [1]. Vascular endothelial growth factor (VEGF) is crucial in angiogenesis because it is highly selective for endothelial cells and reaches its target by diffusion [2,3], and the application of anti-VEGF agents during surgery could contribute to the prevention of CNV progression or recurrence [4,5]. Although the current practice of intravitreal injection of anti-VEGF agents has produced an effective therapeutic response, research has shown that subretinal application can ensure delivery of the drug directly to the site of neovascularization and, thus may enhance the drug efficacy [6].…”

A Case of Unusual Presentation of Massive Submacular Hemorrhage

“…Furthermore, it has been approved that the subretinal injection of TPA is efficient for adult massive submacular hemorrhage. (10) In summary, lucentis, tissue plasminogen activator (TPA) and sulfur hexafluoride gas (SF6) may be a promising strategy for treating massive submacular hemorrhage in old patients. However, this report describes only a single case, with a relatively short follow-up period so far, and randomized controlled clinical studies involving a larger number of patients will be recommended to determine the impact of this management of massive subretinal hemorrhage in elderly patients.…”