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Clinical outcomes of subretinal and intravitreal recombinant tissue plasminogen activator (r-TPA) in macular haemorraghes

Poster Details

First Author: J.Zarranz-Ventura UK

Co Author(s):    S. Fernandez-Perez   P. Tsangaris   M. Brelen   R. Haynes         0   0 0   0 0   0 0   0 0

Abstract Details


To assess the baseline characteristics and clinical outcomes of eyes with macular haemorraghes treated with 1) intravitreal r-TPA + hexafluoride gas (SF6) (IVTPA) and 2) pars plana vitrectomy + subretinal r-TPA injection + SF6 (SRTPA).


Vitreo-Retinal Service, Bristol Eye Hospital, Bristol, UK


Retrospective, systematic case review. Data collected included demographics, baseline characteristics, etiology, surgical details, and 1) visual acuity (VA), 2) qualitative and quantitative characterization of macular haemorrhages by spectral domain-optical coherence tomography (SD-OCT) prior to treatment and at all subsequent follow up visits, 3) previous and posterior anti-VEGF treatments, 4) re-bleeding episodes rate and 5) complications rate.


Fifty-eight eyes of 58 patients with a mean±standard deviation (SD) age of 80±13 (median 82) and a 1.38:1 female to male ratio were included in the study. Forty-five eyes underwent IVTPA and 13 eyes were treated with SRTPA. Baseline mean VA was 1.16±0.6 (median 1), and was 1.13±0.6 for IVTPA and 1.27±0.2 for SRTPA respectively (p=0.20). Blood location was subretinal and sub-retinal pigment epithelium (RPE) in 70.5%, subretinal in 17.6% and sub-RPE in 11.7% of the study eyes. Baseline mean subretinal and sub-RPE blood thickness was 558±287 and 537±303, and at month 3 was 159±74 and 237±124 respectively. Mean VA post-treatment was 0.97±0.5 at month 1, 0.76±0.4 at month 3 and 0.74±0.3 at month 12. Loading dose of anti-VEGF was completed after r-TPA treatment in 43.1% of patients and the re-bleeding episodes rate was 16.1% in a mean time of 19.3 months.


R-TPA treatment provide reasonably good visual and anatomical outcomes in macular haemorrhage cases. Whereas both IVTPA and SRTPA treatment options offer good results, case selection appears critical to optimize visual and anatomical outcomes in each specific case.

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