Rhegmatogenous retinal detachment after injection of tissue plasminogen activator and gas for submacular hemorrhage secondary to age-related macular degeneration.

Abstract

To describe the rate, clinical characteristics and outcomes of rhegmatogenous retinal detachment (RRD) after injection of tissue plasminogen activator (TPA) and gas for submacular hemorrhage (SMH) displacement. Retrospective analysis of consecutive cases developing RRD after TPA injection and gas for SMH displacement. The rate of RRD was calculated and a description of RRD clinical characteristics was carried out. Anatomic and visual outcomes after RRD repair were analyzed. Ninety eyes of 90 patients were analyzed. TPA was given intravitreally in 53 eyes (59%) and subretinally in 37 eyes (41%). RRD occurred in 6/90 eyes (7%). Of these, one had intravitreal TPA and five had vitrectomy with subretinal TPA (p=0.04). The mean age was 75 [64-93] years. The median time of RRD occurrence was 42 [1-134] days. All cases had macular involvement. Two cases had PVR at presentation. Vitrectomy was performed in all cases and silicone oil used in five, all of which resulted in permanent silicone oil retention. One case (17%) achieved primary single surgery success. The median final visual acuity was 1.8 logMAR (20/1260 Snellen). The RRD rate after SMH displacement was 7% in our cases series. RRD occurred more commonly after vitrectomy with sub-retinal TPA injection. The visual and anatomical outcomes were poor, with a high rate of retained silicone oil and recurrent RRD.