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Management of submacular hemorrhage with pars plana vitrectomy and subretinal injection of recombinant tissue plasminogen activator

Session Details

Session Title: Vitreoretinal Surgery II

Session Date/Time: Friday 18/09/2015 | 08:00-10:00

Paper Time: 08:08

Venue: Calliope

First Author: : R.Avci TURKEY

Co Author(s): :    S. Yilmaz   B. Kaderli   U. Inan   C. Kucukerdonmez     

Abstract Details

PURPOSE:Submacular hemorrhage leads to sudden visual decline and can cause permanent visual loss if it is not treated appropriately. In our study, we evaluated the outcome of pars plana vitrectomy (PPV), subretinal recombinant tissue plasminogen activator (r-tPA) injection and intraocular C3F8 gas tamponade for submacular hemorrhage (SMH) when performed within the 3 weeks of the initial symptoms.


To evaluate the outcome of subretinal recombinant tissue plasminogen activator injection for submacular hemorrhage


Consecutive eyes with small to massive SMH covering the foveal center due to different etiologies (13 eyes with age-related macular degeneration(AMD), 2 with retinal arterial macroaneurysm,1 with high myopia and 1 with histiocytosis-x) were included in the study. All eyes were treated with subretinal infusion of 25-microgram/0.1ml r-tPA by 41-g cannula and 5% C3F8 gas tamponade filled to 50-60% of vitreous cavity after PPV. Additionally, 1.25mg/0.05ml anti-VEGF was given to submacular space in patients with AMD. The main outcome measures included complete displacement of SMH from the fovea and best postoperative visual acuity (VA). Snellen VA was converted to logMAR for statistical analysis.


The mean duration of preoperative symptoms was 18.3 days (3-21 days). All patients were followed for a minimum of 3 months (mean, 6.22±2.9 months, range, 3-14 months). SMH was completely displaced from the fovea in 13 cases (82%). Best postoperative VA improved to 20/400 or better levels in 14 eyes. Preoperative and postoperative VA was 2.30±0.73 (3.0-1.0) and 0.69±0.46 (1.3-0) logMAR, respectively (p=0,001). During the follow-up period in patients with AMD, recurred SMH in 3 eyes, intraretinal and subretinal fluid in 5 eyes and submacular fibrosis in 3 eyes were observed and repeated intravitreal anti-VEGF injection was performed in 8 eyes.


PPV, submacular r-tPA injection and intravitreal gas tamponade provides complete displacement of SMH with a significant visual improvement in most of the eyes. Favorable visual outcomes may imply that preoperative duration of SMH up to 3 weeks seems to be reasonable for surgical intervention and hemorrhage did not cause severe toxicity to retinal photoreceptors during this interval.

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