Subretinal injection of recombinant tissue plasminogen activator for submacular hemorrhage associated with ruptured retinal arterial macroaneurysm.

Abstract

PURPOSE:

To evaluate the surgical outcomes of small-gauge vitrectomy with subretinal injection of recombinant tissue plasminogen activator (rt-PA) for a submacular hemorrhage caused by a ruptured retinal arterial macroaneurysm (RAM).

METHODS:

Non-comparative, consecutive case-series performed at two ophthalmological institutions. We examined 22 eyes of 22 patients with a submacular hemorrhage associated with a RAM but without a preretinal or sub-internal limiting membrane hemorrhage at the fovea. During 25-gauge vitrectomy, approximately 4000-8000 IU of rt-PA was injected subretinally, followed by the injection of air or 10 % sulfur hexafluoride as a tamponade. The patients maintained an upright position for 1 hour, then turned to a facedown position for 1 to 3 days. The best-corrected visual acuity (BCVA) and postoperative complications were evaluated.

RESULTS:

The average interval from the onset of symptoms to surgery was 8.4 ± 7.6 days, and the average size of the subretinal hemorrhage was 3.4 ± 1.0 disc diameters. The submacular hemorrhage was displaced from the foveal area in all eyes after 1 week. The mean baseline BCVA was 1.41 ± 0.41 logMAR units, and it improved to 0.91 ± 0.43 at 1 month and to 0.64 ± 0.45 at the final visit (P = 0.0001, P < 0.0001 respectively). A macular hole was detected intraoperatively in two eyes and postoperatively in two eyes, and both were closed by internal limiting membrane peeling or a second vitrectomy.

CONCLUSIONS:

Small-gauge vitrectomy with subretinal rt-PA injection and gas tamponade were effective in displacing a submacular hemorrhage associated with a RAM.

• Authors: Makoto Inoue, Fumio Shiraga, Yukari Shirakata, Yuki Morizane, Shuhei Kimura, Akito Hirakata
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 253 Issue 10 Pg. 1663-9 (Oct 2015) ISSN: 1435-702X [Electronic] Germany
• PMID: 25418034 (Publication Type: Journal Article)

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator
• Sulfur Hexafluoride

Topics

• Aged
• Aged, 80 and over
• Aneurysm, Ruptured (complications)
• Combined Modality Therapy
• Endotamponade
• Female
• Fibrinolytic Agents (therapeutic use)
• Humans
• Injections, Intraocular
• Male
• Middle Aged
• Prone Position
• Retinal Artery (pathology)
• Retinal Hemorrhage (diagnosis, drug therapy, etiology)
• Sulfur Hexafluoride (administration & dosage)
• Tissue Plasminogen Activator (therapeutic use)
• Tomography, Optical Coherence
• Visual Acuity (physiology)
• Vitrectomy