Displacement of Submacular Hemorrhages in Age-Related Macular Degeneration with Subretinal Tissue Plasminogen Activator and Air

Abstract

To study the anatomic and visual outcomes of a surgical procedure in which tissue plasminogen activator and air are injected subretinally to displace massive submacular hemorrhages secondary to age-related macular degeneration. Prospective, consecutive, interventional case series. Thirteen consecutive patients (13 eyes) with massive submacular hemorrhages secondary to age-related macular degeneration. The surgical procedure consisted of a 25-gauge vitrectomy and submacular injection of tissue plasminogen activator (25 μg) and 0.4 ml air with a microneedle having an outer diameter of 50 μm. The procedure was followed by having the patient remain in the prone position overnight. Mean visual acuity change from baseline, mean central lesion thickness change from baseline, fluorescein angiography findings, and surgical complications. Total subfoveal blood displacement was achieved in all 13 eyes (100%). Central lesion thickness decreased from a mean baseline value of 867 μm to a mean value of 379 μm at 1 month after surgery. There was visual improvement in 11 eyes, no visual improvement in 1 eye, and poorer vision in 1 eye. The mean change in Early Treatment Diabetic Retinopathy Study letter score from baseline was 19.4 letters at 1 month (P = 0.006) and 23.3 letters at 3 months (P = 0.001). There was intraoperative macular hole formation. Submacular air injection with a microneedle facilitates displacement of clots dissolved with tissue plasminogen activator with few complications and results in earlier visual improvement.