Intravitreal Injection of tPA and Gas for Submacular Hemorrhage Associated with Age-related Macular Degeneration

Abstract

Purpose: To study the results of intravitreal tissue plasminogen activator (tPA) and expansile gas injection for the treatment of submacular hemorrhage in age-related macular degeneration (AMD). Methods: Eleven consecutive patients (11 eyes) with submacular hemorrhage in AMD were included in this study. All patients were treated with intravitreal injections of tPA and C3F8 gas. Postoperatively, patients' follow-up period were at least 3 months. Outcome measures included early and final visual acuity, age, disc areas of hemorrhage, duration of symptoms, displacement of blood from the fovea, and final macular status. Results: The maximum diameter of the hematoma ranged from 2 to 10 disc diameters. The mean duration of submacular hemorrhage was 7.5 days. Submacular blood was completely displaced in 7 patients (64%) and partially in four (36%). Best postoperative visual acuity improved in 7 eyes; in 6 eyes (55%), the improvement was two or more lines. Final visual acuity improved in 7 eyes (64%), remained stable in 2 eyes (18%), and worsened in 2 eyes (18%). Choroidal neovascularization positioned at subfovea in 7 eyes (64%) and juxtafovea in 4 eyes (36%). No significant difference was found between postoperative visual recovery and these factors. Conclusions: Our findings suggest that intravitreal tPA and expansile gas injection are safe and of useful for displacing hemorrhages secondary to age-related macular degeneration. Final visual acuity was limited by the underlying choroidal neovascularization of AMD.