Recombinant Tissue Plasminogen Activator (rtPA) in the Treatment of Macular Hemorrhages

Abstract

Macular hemorrhage is a frequent complication of retinal macroaneurysms and represents a threat to central vision. We report the surgical use of recombinant tissue plasminogen activator (rtPA) in the treatment of macular hemorrhage. Two eyes of 2 female patients with macular hemorrhage from ruptured retinal macroaneurysms were treated with subretinal rtPA injection. Visual acuities on admission were of counting fingers (<20/400) in the 2 eyes treated. Best corrected visual acuity improved to 20/100. No major intraoperative complications were reported. Macular hemorrhage presents a low rate of spontaneous resolution and, left untreated, portends a poor prognosis. Subretinal injection of rtPA is a challenging, yet effective surgical technique, with rates of hemorrhage displacement reported between 50%-90%.