Treating Submacular Hemorrhage with Intravitreal tPA Injection and Pneumatic Displacement
Asian Journal of Research and Reports in Ophthalmology,
Background: This report describes the clinical outcome in an adult male with spontaneous submacular hemorrhage who underwent successful intravitreal tPA injection and pneumatic displacement.
Case Presentation: A 30 yr old male patient presented with complaints of sudden painless diminution of vision in left eye since one day. The vision on presentation was Hand Movements +. Fundus showed a submacular hemorrhage with breakthrough vitreous hemorrhage. Injection tPA (25μg in 0.05 ml) and pure sulfur hexafluoride (SF6, 0.3 ml) was injected into the vitreous cavity. After surgery the patient was instructed to maintain a prone position. This was followed by a vitrectomy after 2 weeks. Postoperatively, patient had significantly improved having an unaided vision of 6/9P in the left eye which improved to 6/6 on correction.
Conclusion: Intravitreal tPA and pneumatic displacement using pure SF6 is an effective treatment for submacular hemorrhage.
- Submacular hemorrhage
- pneumatic displacement
- SF6 gas.
How to Cite
Casini G, et al. Traumatic submacular hemorrhage: Available treatment options and synthesis of the literature. International Journal of Retina and Vitreous. 2019;5. Article number: 48.
Herriot WJ. Intravitreal gas and tPA: An outpatient procedure for submacular hemorrhage; AAO Annual Vitreoretinal Update, Chicago, Ill, USA; 1996.
Hochman MA, Seery CM, Zarbin MA. Pathophysiology and management of subretinal hemorrhage. Survey of Ophthalmology. 1997;4(2).
Hesse L. Treating subretinal hemorrhage with tissue plasminogen activator. Archives of Ophthalmology. 2002;120(1):102–203.
Hesse L, Schmidt J, and Kroll P. Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas; Graefe’s Archive for Clinical and Experimental Ophthalmology. 1999;237(4):273–277.
Chen SN, Yang TC, Ho CL, Kuo YH, Yip Y, Chao AN.Retinal toxicity of intravitreal tissue plasminogen activator: Case report and literature review. Ophthalmology. 2003;110(4):704–708.
Lewis H, Resnick SC, Flannery JG, Straatsma BR. Tissue plasminogen activator treatment of experimental subretinal hemorrhage. American Journal of Ophthalmology. 1991;111(2):197–204.
Coll GE, Sparrow JR, Marinovic A, Chang S. Effect of intravitreal tissue plasminogen activator on experimental subretinal hemorrhage; Retina. 1995;15(4):319–326.
Boone DE, Boldt HC, Ross RD, Folk JC, Kimura AE. The use of intravitreal tissue plasminogen activator in the treatment of experimental subretinal hemorrhage in the pig model; Retina. 1996;16(6):518– 524.
Kimura AE, Reddy CV, Folk JC, Farmer SG. Removal of subretinal hemorrhage facilitated by preoperative intravitreal tissue plasminogen activator; Retina (Philadelphia, Pa.). 1994;14(1):83-84.
Hesse L, Schroeder B, Heller G, and Kroll P.Quantitative effect of intravitreally injected tissue plasminogen activator and gas on subretinal hemorrhage retina. 2000;20(5):500–505.
Goldman DR, Vora RA, Reichel E. Traumatic choroidal rupture with submacular hemorrhage treated with pneumatic displacement. Retina. 2014; 34(6):1258–1260.
Holland D, Wiechens B. Intravitreal r-TPAand gas injection in traumatic submacular hemorrhage. Ophthalmologica. 2004;218 (1):64–69.
Tsuyama T, Hirose H, Hattori T. Intravitreal tPA Injection and Pneumatic Displacement for Submacular Hemorrhage in a 10-Year-Old Child; Hindawi Publishing Corporation, Case Reports in Ophthalmological Medicine. 2016;Article ID: 9809583.
Balughatta P, Kadri V, Braganza S, Jayadev C, Mehta RA, Nakhate V, et al. Pneumatic displacement of limited traumatic submacular hemorrhage without tissue plasminogen activator: a case series. Retin Cases Brief Rep. 2019;13: 34–8.
Doi S, Kimura S, Morizane Y, et al. 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. BMC Ophthalmology. 2015;15: Article 94.
Kunavisarut P, Thithuan T, Patikulsila D, Choovuthayakorn J, Watanachai N, Chaikitmongkol V, et al.Submacular hemorrhage: Visual outcomes and prognostic factors. Asia Pac J Ophthalmol. 2018;7:109–13.
Ching J, et al. Pneumatic displacement with intravitreal Plasminogen Activator (PA) versus Vitrectomy with Subretinal PA for Submacular Haemorrhage. Austin J Clin Ophthalmol. 2019;6(1):1099.
Abstract View: 32 times
PDF Download: 10 times