Tissue Plasminogen Activator and Pneumatic Displacement in Treatment of Submacular Hemorrhage
Narrative Responses:
Purpose
Submacular hemorrhage is a common sight-threatening complication in various retinal diseases. Surgical management carries a high risk of complications. This study aims to evaluate the safety and efficacy of a minimally invasive technique to treat submacular hemorrhage using tissue plasminogen activator (TPA) and pneumatic displacement.
Methods
A 10-year cohort study of consecutive patients presenting with submacular hemorrhage was performed. Intravitreal injection of 0.05ml TPA was given, followed by pneumatic displacement using 0.3ml perfluoropropane gas. Risk factors for long-term success and visual outcomes were assessed using multivariate analysis.
Results
Sixty-three patients, mean age 63.5 years, had a single-treatment success rate of 89.3% (66.1% with blood displacement; 23.2% with blood dispersion). Age-related macular degeneration was the cause of submacular hemorrhage in 23 patients (36.5%) and Polypoidal choroidal vasculopathy (PCV) accounted for 36 (57.1%). Forty-seven patients (74.6%) had improved or no deterioration of visual acuity (VA), with 35 (55.5%) gaining ≥2 Snellen lines of vision after treatment. Good visual outcomes (final VA ≥6/12) were achieved in 69% (45.9% of patients who had clinical displacement; 23.1% with dispersion; none in those without displacement or dispersion).
Conclusion
TPA and pneumatic displacement of submacular hemorrhage is minimally invasive, efficacious and safe.Good visual outcomes can be achieved, especially in younger patients.