Abstract
Describe a case report on the efficacy and visual outcomes after rTPA and gas injection in acute submacular haemorrhage due to retinal artery macroaneurysm. A 72 years old woman arrived around a week after her visual acuity decreased to 20/125 in the right eye. Left eye had 20/20. Slit lamp examination showed a moderate nuclear cataract. Funduscopic examination revealed a subretinal haemorrhage involving the fovea with a major leakage in the superior temporal area. Pure sulfur hexafluoride (0.2 cc) and 50 μg of rTPA were injected via the pars plana into the vitreous cavity. After the procedure, the patient was advised to maintain prone position during 6 days. No complications were observed. The edematous region around the macroaneurysm was treated by laser five months after surgery. After injection the subfoveal blood was totally displaced to the periphery as shown by funduscopy and fluorescein angiography. A visual acuity of 20/40 (6 lines gain) was observed after one month, and was stable at six months follow up. rTPA and gas injection was an efficient treatment in this patient with macular haemorrhage due to retinal artery macroaneurysm. Larger study is needed in order to understand if it can reduce the risk of fibrin toxicity.
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