Vitrectomy combined with subretinal injection of tissue plasminogen activator for successful treatment of massive subretinal hemorrhage

Abstract

Purpose: To evaluate the outcome of vitrectomy combined with a subretinal injection of tissue plasminogen activator (tPA) to treat a massive subretinal hemorrhage. Methods: The medical records of 11 eyes of 11 patients (seven men, four women, mean age; 74.5 ± 9.6 years) with a massive (>10 disc area) subretinal hemorrhage were reviewed. The patients were treated with vitrectomy combined with a subretinal injection of tPA with or without external drainage. Results: The mean baseline visual acuity was 2.10 ± 0.45 logarithm of the minimum angle of resolution (logMAR) units. The hemorrhage was externalized in three eyes due to bullous hemorrhagic retinal detachment. The subretinal hemorrhage was displaced away from the fovea in 10 eyes (91%) and reduced in one eye. Retinal reattachment was achieved in all eyes however reoperations were needed in five eyes (45%) among the eight eyes (73%) with recurrent vitreous and/or subretinal hemorrhages. The postoperative vision at 3 months was significantly improved to 1.32 ± 0.65 logMAR units ( p = 0.0076). The vision in the two eyes without postoperative subretinal hyperreflective material at the fovea recovered to 0.4 logMAR units but none of the nine eyes with the foveal subretinal hyperreflective material had vision better than 0.1 logMAR units. Conclusion: Vitrectomy with subretinal injection of tPA with or without external drainage of the subretinal hemorrhage was effective in treating massive subretinal hemorrhages.

Three-dimensional heads-up system assisted pars plana vitrectomy and subretinal recombinant tissue plasminogen activator injection for submacular hemorrhage

“…Here, we observed the occurrence of VH, SMH, and RD as postoperative complications, which were also reported in previous studies [ 5 , 6 , 30 ]. Based on our surgical experience, two possible explanations were proposed for the occurrence of these complications.…”

“…To minimize retina damage and surgical complications, Kadonosono et al [31] used the 47-gauge (50 μm) microneedle in their surgical procedures. Saito-Uchida et al [5] reported SMH and/or VH recurrence rate of 73% in 11 eyes after subretinal injection of rt-PA using the TM system and 5 (45%) more surgeries were needed to manage these complications. Other studies reported that 9 (60%) of 15 eyes and 10 (41.6%) of 24 eyes required at least one additional surgery for managing the postoperative complications of SMH, VH, or RD [32,33].…”

“…However, the application of the 3D heads-up system in the treatment of SMH has not been evaluated. Second, the best way to reduce the risk of postoperative retinal detachment (RD) and recurrence of SMH and vitreous hemorrhage (VH) remains unknown [ 5 ]. Previous studies reported that the risk of these surgery-related complications was high, and sometimes repeated vitrectomies were needed [ 6 , 15 ].…”

“…The intravitreal or subretinal injection of recombinant tissue plasminogen activator (rt-PA) in treating SMH has been evaluated by many studies. The displacement of SMH by subretinal injection of rt-PA combined with pars plana vitrectomy (PPV) and vitreous cavity tamponade showed a promising prognosis and had become the standard therapy for treating SMH patients [5][6][7]. However, several issues of this novel treatment strategy still need to be settled.…”

Subretinal recombinant human tissue plasminogen activator injection using a 41G needle for the management of submacular hemorrhages: a 3-case report

“…Liu et al [7] reported good results using a 30-gauge (30G) needle for external drainage of subretinal hemorrhages through a scleral tunnel during vitrectomy. Saito-Uchida et al [8] reported subretinal injection of tPA with a 38G needle in 11 cases of subretinal hemorrhage, and retinal reattachment was achieved in all eyes. Venkatesh et al [9] reported that 25G pars plana vitrectomy (PPV) was performed along with injection of vancomycin directly into the subretinal abscess in endogenous endophthalmitis using a 41G needle, which improved the visual acuity to 6/24.…”