Injection Of Tissue Plasminogen Activator Research Articles

Vitrectomy With tPA for Submacular Hemorrhage Following Domestic Abuse.

A 35-year-old woman presented with visual acuity of 20/400 due to submacular hemorrhage 24 hours after confirmed domestic abuse with blunt trauma to the head. Surgical intervention with pars plana vitrectomy, subretinal tissue plasminogen activator (tPA) injection, and fluid-air exchange yielded prompt resolution of the pathology, regaining functional vision of 20/40 and an ability to return to work within one week. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Pneumatic displacement with intravitreal tPA injection versus vitrectomy with sub retinal tPA injection in small and medium sub macular hemorrhages- a multicenter comparative study

PurposeComparing between the visual outcomes and post operative complications of two surgical treatments for sub macular hemorrhage, pars plana vitrectomy with tissue plasminogen activator (tPA) injection procedure, and pneumatic displacement of submacular hemorrhage with intravitreal tPA injection.MethodsA retrospective chart review of patients with sub macular hemorrhage (SMH) was performed. Data was collected from 150 patients with sub macular hemorrhage. Patients were followed up from the day of admission and up to a year post surgery. Evaluation included visual acuity, optical coherence tomography (OCT), fundus examination and rates of complications.ResultsPars plana vitrectomy procedure has showed a better visual outcome in small SMH. Comparing complications between the two treatment modalities, no significant difference has been found in the study.ConclusionsPars plana vitrectomy and tPA showed a clear advantage with a trend of better visual acuity as well as a significant predictor to better visual acuity for small and medium sub macular hemorrhage.

Displacement of Submacular Hemorrhage Using Subretinal Cocktail Injection versus Pneumatic Displacement: A Real-World Comparative Study

Introduction: The objective of this study was to compare the outcome of submacular hemorrhage (SMH) displacement using pneumatic displacement with intravitreal expansile gas versus pars plana vitrectomy (PPV) with subretinal injection of tissue plasminogen activator (tPA), anti-vascular endothelial growth factor (VEGF) agent, and air as primary surgery. Methods: Retrospective interventional case series of 63 patients who underwent surgical displacement of SMH secondary to neovascular age-related macular degeneration (nAMD) or polypoidal choroidal vasculopathy (PCV) from May 1, 2015, to October 31, 2022. Medical records were reviewed for diagnosis, logMAR visual acuity (VA), central subfield thickness (CST), and postoperative displacement rates and complications up to 12 months after operation. Results: The diagnosis was nAMD in 24 (38.1%) and PCV in 39 (61.9%) eyes. There were 40 (63.5%) eyes in the pneumatic displacement group (38 received C3F8, 2 received SF6) and 23 (36.5%) eyes in the subretinal cocktail injection. Mean baseline VA was 1.46 and 1.62, respectively (p = 0.404). The subretinal injection group had more extensive SMH (p = 0.005), thicker CST (1,006.6 μm vs. 780.2 μm, p = 0.012), and longer interval between symptom and operation (10.65 vs. 5.53 days, p < 0.001). The mean postoperative VA at 6 months was 0.67 and 0.91 (p = 0.180) for pneumatic displacement and subretinal injection groups, respectively, though VA was significantly better in the pneumatic group at 12-month visit (0.64 vs. 1.03, p = 0.040). At least 10 mean change in VA were >10 letters gain in both groups up to 12 months. Postoperative CST reduction was greater (625.1 μm vs. 326.5 μm, p = 0.008) and complete foveal displacement (87.0% vs. 37.5%), p < 0.001, odds ratio [OR] = 11.1) and displacement to arcade or beyond (52.5% vs. 17.5%, p = 0.009, OR = 5.15) were more frequent in the subretinal injection group. Two patients with failed pneumatic displacement were successfully treated with subretinal cocktail injection as a second operation. Conclusion: Surgical displacement of SMH leads to clinically meaningful improvement in VA. PPV with subretinal cocktail injection is more effective than pneumatic displacement in displacing SMH with similar safety profile despite longer interval before operation, higher CST, and more extensive SMH at baseline. Retinal surgeons could consider this novel technique in cases with thick and extensive SMH or as a rescue secondary operation in selected cases.

Is Intravitreal Injection of Recombinant Tissue Plasminogen Activator Effective for the Treatment of Refractory Diabetic Macular Edema in Patients With Posterior Vitreous Detachment?

To determine whether intravitreal injection of recombinant tissue plasminogen activator (rTPA) is effective for the treatment of refractory diabetic macular edema (DME) in patients who already had posterior vitreous detachment (PVD). It is a retrospective chart review of the patients with refractory DME and PVD. The efficacy of intravitreal injection of rTPA was assessed based on the changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) in these patients. Nine eyes of nine patients as the study group and 14 eyes of the 14 patients as the control group were examined. Before the injections, the mean CMT was 470.0± 107.6 in the study group, compared to 536.2± 150.5 in the control group, with no statistical significance (p=0.403). The statistical analysis revealed no significant differences in the mean changes in CMT from baseline to one and three months after injections between the study and control groups (p=0.439, p=0.781, respectively). Likewise, no statistically significant disparities were observed in the mean pre-injection BCVA between the study group (0.877± 0.349) and the control group (0.950± 0.300) (p=0.415). Additionally, after three months of injection, there were no significant changes in the mean BCVA of the study group (0.844± 0.304) and the control group (0.864± 0.253) (p=0.512). This study showed that rTPA has no effect on changes in CMT and BCVA in patients who had refractory DME and PVD at the same time. This may suggest that the improvement in CMT in previous studies may be due to the induction of PVD.

Vitrectomy with subretinal tissue plasminogen activator and intravitreal injection of bevacizumab in the treatment of submacular haemorrhage secondary to wet AMD – case series

Vitrectomy with subretinal tissue plasminogen activator and intravitreal injection of bevacizumab in the treatment of submacular haemorrhage secondary to wet AMD – case series

PREDICTORS OF 3-MONTH AND 1-YEAR VISUAL OUTCOMES AFTER VITRECTOMY WITH SUBRETINAL TISSUE PLASMINOGEN ACTIVATOR INJECTION FOR SUBMACULAR HEMORRHAGE.

To investigate factors associated with 3-month or 1-year best-corrected visual acuity (BCVA) after vitrectomy with subretinal tissue plasminogen activator injection for submacular hemorrhage (SMH) and to identify the predictors of early displacement. This prospective cohort study included consecutive eyes with SMH complicating neovascular age-related macular degeneration or retinal macroaneurysm that underwent vitrectomy with subretinal tissue plasminogen activator injection and were followed up for at least 3 months. Parameters that correlated with 3-month BCVA, 1-year BCVA, and 2-week displacement grade (0-3) were identified. Twenty-nine eyes of 29 patients (73.1 ± 8.4 years; neovascular age-related macular degeneration, 25 eyes) were included. Logarithm of the minimum angle of resolution BCVA improved 3 months after the surgery (baseline, 0.76 [20/115] ± 0.35; 3-month, 0.51 [20/65] ± 0.32; P = 0.006). In multivariable analyses, 1-year logarithm of the minimum angle of resolution BCVA correlated with age ( P = 0.007, β = 0.39) and SMH recurrence within 1 year after surgery ( P < 0.001, β = 0.65). Two-week displacement grade correlated with the contrast-to-noise ratio of SMH ( P = 0.001, β = -0.54). Macular hole occurred in three eyes (10%) with small SMH size and was closed in all eyes via additional vitrectomy with an inverted internal limiting membrane flap technique. The recurrence of SMH negatively affected the 1-year visual outcome after vitrectomy with subretinal tissue plasminogen activator injection for SMH. The contrast-to-noise ratio was a useful predictor of early SMH displacement, but not of 1-year BCVA. Further research is necessary to determine the optimal treatment to prevent SMH recurrence.

A Systematic Review of Robot-assisted vs Manual Vitreoretinal Surgery: Is it Feasible?

Introduction and Objectives: Vitreoretinal surgery requires high precision and fine manipulation of instruments, which can be challenging due to human physiological barriers such as tremors, jerks, and low-frequency drifts. Robotic assistance carries the potential to overcome these limitations by providing better stability and filtering involuntary movements, therefore improving safety and future opportunities for this complex procedure. This review aims to compare the feasibility and safety of robot-assisted and manual vitreoretinal surgery. Methods: A comprehensive literature search was performed on 4 online databases: PubMed, Cochrane, ProQuest, ScienceDirect, and hand searching. Human studies comparing robot-assisted and manual vitreoretinal surgery, English language, and full-text journal available were included in this review. We identified the feasibility, safety, and duration of the robot-assisted approach for vitreoretinal surgery as the main outcome measurements. Results: Three randomized controlled trials (RCTs) with a total of 45 adults were evaluated. Robotic assistance was performed on various different vitreoretinal surgery procedures, including subretinal injection of tissue plasminogen activator (TPA), peeling of epiretinal membrane (ERM), and internal limiting membrane (ILM), with one study performed both procedures. All three studies showed surgical steps carried out with robotic assistance were successfully performed without clinical complications observed. The duration was longer in robot-assisted surgery compared to manual surgery. The number of retinal microtrauma was less frequent in robot-assisted surgery compared to manual surgery. Conclusion: Even though the duration of surgery took longer in the robot-assisted group, all studies show the feasibility and safety of robotic assistance in vitreoretinal surgery. However, further studies with larger samples are needed. Keywords:robot-assisted surgery, manual surgery, vitreoretinal surgery .

Assessment of effectiveness and safety of thrombolytic therapy to pulmonary emboli by endobronchial ultrasound-guided transbronchial needle injection

ObjectiveEndobronchial ultrasound–guided transbronchial needle injection (EBUS-TBNI) may effectively treat acute pulmonary embolisms (PEs). Here, we assessed the effectiveness of clot dissolution and safety of tissue plasminogen activator (t-PA) injection using EBUS-TBNI in a 1-week survival study of a porcine PE model. MethodsSix pigs with bilateral PEs were used: 3 for t-PA injection using EBUS-TBNI (TBNI group) and 3 for systemic administration of t-PA (systemic group). Once bilateral PEs were created, each 25 mg of t-PA injection using EBUS-TBNI for bilateral PEs (a total of 50 mg t-PA) and 100 mg of t-PA systemic administration was performed on day 1. Hemodynamic parameters, blood tests, and contrast-enhanced computed tomography scans were carried out at several time points. On day 7, pigs were humanely killed to evaluate the residual clot volume in the pulmonary arteries. ResultsThe average of percent change of residual clot volumes was significantly lower in the TBNI group than in the systemic group (%: systemic group 36.6 ± 22.6 vs TBNI group 9.6 ± 6.1, P < .01) on day 3. Considering the elapsed time, the average decrease of clot volume per hour at pre-t-PA to post t-PA was significantly greater in the TBNI group than in the systemic group (mm3/hour: systemic 68.1 ± 68.1 vs TBNI 256.8 ± 148.1, P < .05). No hemorrhage was observed intracranially, intrathoracically, or intraperitoneally on any contrast-enhanced computed tomography images. ConclusionsThis study revealed that t-PA injection using EBUS-TBNI is an effective and safe way to dissolve clots.

Prognostic factors for visual acuity improvement after treatment of submacular hemorrhage secondary to exudative age-related macular degeneration.

To recognize prognostic factors for better final visual acuity (VA) in patients presenting with submacular hemorrhage (SMH) secondary to exudative age-related macular degeneration. This retrospective study included patients who presented to a tertiary ophthalmology department between 2012 and 2019 with SMH and were treated by pars plana vitrectomy (PPV) or injection of tissue plasminogen activator (tPA) with pneumatic displacement. Baseline characteristics included demographic data, VA and optical coherence tomography (OCT) characteristics of the SMH. Patients were divided into groups by improvement of at least 2 lines in BCVA (best corrected visual acuity), and by having a final BCVA better than 20/200. Forty-three eyes of 43 patients were included. Mean age was 86.72 ± 7.18. Prognostic factors for final VA better than 20/200 included better VA at presentation (1.25 vs 1.90 logMAR, p < 0.001), smaller area of SMH in the infra-red image (19.47 mm2 vs 38.45 mm2, p = 0.024), and lower height of SMH as measured by OCT (713.5 µm vs 962.5 µm, p = 0.03). Third of the patients improved in ≥2 lines from presentation, all in the group of the pneumatic and TPA displacement. Smaller SMHs with good VA at presentation have a better chance for improvement and result in a better final VA. These patients may benefit the most from pneumatic displacement of the SMH with intravitreal tPA and gas.

Comparison of the effectiveness and side effects of intravenous TPA injection in acute stroke patients between 0 to 4.5 hours and the first 4.5 to 6 hours from the onset of symptoms (P7-5.018)

<h3>Objective:</h3> To compare the effectiveness and side effects of intravenous tissue plasminogen activator (TPA) injection in acute stroke patients between 0 to 4.5 hours and the first 4.5 to 6 hours from the onset of symptoms. <h3>Background:</h3> rTPA injection in acute stroke patients between 4.5 to 6 hours from the onset of symptoms has not been approved by health protocol and most of those patients die due to that protocol. <h3>Design/Methods:</h3> This retrospective cohort study of all ischemic stroke patients referred to Valiasr Hospital in Zanjan between 96 and 1400 hospitalizations in the SCU department were examined. Two groups were considered, the delayed group included patients who received intravenous TPA in 4.5 to 6 hours, and the standard group included patients who received intravenous TPA in the first 4.5 hours.NIHSS and MRS between the two groups at the time of admission, at the time of discharge, and after three months were compared. <h3>Results:</h3> Of these 75 subjects, 50 were in the standard group, and 25 were in the delayed group. The average MRS at the first admission, discharge, and 90 days after discharge in the delayed group was 0.6±0.2, 1.7±1.5, and 1.8±1.5, respectively. There was a significant difference between the two standard and delayed groups in terms of the time from the onset of symptoms to referral and the time of TPA injection (P value&lt;0.05) and MRS at the time of the admission. Furthermore, in the delayed group, there were a significant relationship between NIHSS at the first admission and discharge and also MRS at the time of discharge and 90 days after discharge (P value&lt;0.05). <h3>Conclusions:</h3> The effectiveness of injections between 4.5 and 6 hours and injections between 0 and 4.5 hours are not different from each other in terms of complications and mortality. <b>Disclosure:</b> Dr. Maghbooli has nothing to disclose.

Subretinal recombinant human tissue plasminogen activator injection using a 41G needle for the management of submacular hemorrhages: a 3-case report.

Subretinal recombinant human tissue plasminogen activator injection using a 41G needle for the management of submacular hemorrhages: a 3-case report.

Гравитационная дислокация субмакулярных кровоизлияний у пациентов с возрастной макулярной дегенерацией

Purpose. To study the effectiveness and anatomical results of gravitational dislocation of submacular hemorrhages in patients with age-related macular degeneration. Material and methods. We examined 4 patients (4 eyes) with the diagnosis of submacular hemorrhages. The average age of the subjects was 71.45 ± 5.15 years. The duration of the disease was 7determined from the onset of characteristic symptoms to surgical treatment and averaged 7.5 ± 4 days. The maximum corrected acuity averaged 0.02 ± 0.05. According to the data of optical coherence tomography, a high central detachment of the neuro- and pigment epithelium with hemorrhagic contents was determined in patients. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. All patients underwent pars plana vitrectomy combined with subretinal tissue plasminogen activator (t-PA) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection without any tamponade. The patients were advised to take supine position postoperatively in order t-PA to liquefy the haemorrhage, for 1 h; after which they were positioned upright or lying down on the temporal side of the affected eye, for 3 days. Results. In the early surgical period, there was a tendency to increase the maximum corrected visual acuity (MCI): on the 7th day after the first stage of treatment, it was 0.23 ± 0.06 (p &lt; 0.05 compared with the indicators before treatment). The displacement of the blood clot from the central area of the retina, with the correct positioning of the patient, occurred within 5.87 ± 1.9 days. Lysis of the submacular clot was observed for 14 ± 1.53 days. After 3 loading injections carried out within 1.2 and 3 months after the operation, the MCI increased to 0.4 ± 0.2. Conclusion. Microinvasive subtotal vitrectomy with subretinal injection of Prourokinase, with proper positioning of the patient, help gravitational dislocation of submacular hemorrhages and is an effective treatment method in patients with age-related macular degeneration. Keyword: submacular hemorrhage, age-related macular degeneration, dislocation, optical coherence tomography

Three-dimensional heads-up system assisted pars plana vitrectomy and subretinal recombinant tissue plasminogen activator injection for submacular hemorrhage

BackgroundTo evaluate the outcomes of three-dimensional (3D) heads-up system assisted pars plana vitrectomy (PPV) and subretinal injection of recombinant tissue plasminogen activator (rt-PA) for submacular hemorrhage (SMH).MethodsMedical records of SMH patients who underwent 3D heads-up system assisted-PPV and subretinal injection of rt-PA from June 2021 to January 2022 were reviewed. The main outcomes included best-corrected visual acuity (BCVA), SMH absorption, and perioperative complications.ResultsWe finally included 18 SMH eyes, most of which happened secondary to polypoidal choroidal vasculopathy (PCV) (10, 55.56%), followed by retinal arterial microaneurysm (RAM) (5, 27.78%), traumatic retinopathy (2, 11.11%) and neovascular age-related macular degeneration (nAMD) (1, 5.56%). The greatest linear dimension (GLD) and height of SMH were 6538.17 ± 2533.11 μm and 937.36 ± 420.21 μm, respectively. After an average postoperative follow-up period of 131.06 ± 38.96 days, patients’ BCVA improved significantly from 1.85 ± 0.62 to 1.14 ± 0.82 logMAR (P < 0.05). SMH was completely and partially absorbed in 9 (50.00%) and 6 (33.33%) eyes, with no occurrence of iatrogenic retinal break. However, 4 additional PPVs were performed to manage the postoperative SMH and/or vitreous hemorrhage (VH) recurrence (2, 11.11%) and retinal detachment (RD) occurrence (2, 11.11%). Preoperative BCVA was significantly correlated with postoperative BCVA in multiple linear regression analysis (P < 0.05), and hemorrhagic pigment epithelial detachment (PED) was significantly correlated with SMH and VH recurrence in univariate binary logistic regression analysis (P < 0.05).ConclusionsThe 3D heads-up system assisted-PPV and subretinal injection of rt-PA were efficacious in eliminating SMH and improving visual prognosis with satisfactory safety profile, while caution should be taken for PCV patients with hemorrhagic PED and massive SMH.

Efficacy Evaluation of Tissue Plasminogen Activator with Anti-Vascular Endothelial Growth Factor Drugs for Submacular Hemorrhage Treatment: A Meta-Analysis.

Submacular hemorrhage (SMH) is the accumulation of blood in the macular area that can severely damage the macular structure and visual function. Recently, the intraocular administration of tissue plasminogen activator (TPA) with anti-vascular endothelial growth factor (anti-VEGF) drugs was reported to have a positive effect on SMH. This meta-analysis aimed to explore the efficacy and safety of the drug combination. We systematically searched the Web of Science, MEDLINE, EMBASE, and Cochrane Library databases and screened relevant full-length literature reports. The quality of the reports was assessed by two independent reviewers. The best-corrected visual acuity (BCVA) and foveal thickness (FT) were considered the main indicators of efficacy. RevMan 5.4 software was used for this meta-analysis. Twelve studies were analyzed, and the results showed that BCVA at 1 month (p < 0.001), 3 months (p < 0.001), 6 months (p < 0.001), and the last follow-up (p < 0.001) was improved relative to the preoperative value. The postoperative FT was lower than the preoperative FT (p < 0.001). No significant difference in efficacy was observed between subretinal and intravitreal TPA injections (p = 0.37). TPA with anti-VEGF drugs is safe for SMH treatment and can significantly improve BCVA and reduce FT.

Hemorrhagic Retinal Detachment Treated by Drainage Sclerotomy Combined with Subretinal and Submacular Tissue Plasminogen Activator

Introduction: The aim of this study was to evaluate the therapeutic effect of a new drainage procedure for treating subretinal hemorrhage (SRH) in hemorrhagic retinal detachment (RD) in patients with polypoidal choroidal vasculopathy (PCV). Methods: Forty-three eyes with hemorrhagic RD attributable to PCV underwent vitrectomy. External drainage via sclerotomy was performed in 25 eyes and internal drainage via retinotomy was performed in 18 eyes, respectively. Based on different surgical techniques, the external drainage group was divided into simple external drainage subgroup (10 eyes), external drainage combined with intravitreal injections of recombinant tissue plasminogen activator (tPA) subgroup (7 eyes), and external drainage combined with subretinal and/or submacular injections of tPA subgroup (8 eyes). The internal drainage group was divided into small retinotomy subgroup (7 eyes) and large retinotomy subgroup (11 eyes). The anatomic reattachment of the retina and postoperative complications were compared between different groups and subgroups. Results: The external drainage technique had shorter mean operation time, higher retinal reattachment rate, and fewer postoperative complications rate compared to the internal drainage procedure. The subfoveal hemorrhage subsided significantly sooner in the large retinotomy subgroup and external drainage combined with subretinal and/or submacular injections of tPA subgroup compared to the small retinotomy subgroup and the external drainage without tPA group (p < 0.05). The small retinotomy subgroup had higher rates of hemorrhage and elevated IOP compared to other subgroups during the first week of the postoperative period (p < 0.05). Conclusion: Our results suggest that external drainage of SRH combined with subretinal and/or submacular injections of tPA can make the operation simpler, shorten the operation time, reduce the postoperative complications with rapid regression of subfoveal hemorrhage, resulting in an effective and safe therapeutic strategy for treating hemorrhagic RD.

Displacement of submacular hemorrhage secondary to age-related macular degeneration with subretinal injection of air and tissue plasminogen activator

Submacular hemorrhage (SMH) can lead to devastating visual loss in patients with age-related macular degeneration. We retrospectively evaluated the surgical outcomes of vitrectomy with subretinal injection of tissue plasminogen activator, bevacizumab, and air in 13 cases. Visual prognosis, anatomical results obtained with optical coherence tomography (OCT), and their correlations were investigated. We analyzed OCT parameters including SMH height, pigment epithelial detachment (PED) height and width, and status of ellipsoid zone (EZ) line. Complete displacement of SMH was achieved in 12 eyes. At 3 months post-surgery, best-corrected visual acuity (BCVA) and SMH height exhibited significant improvements (P < 0.01). In eyes with preoperative SMH height < 300 µm and a detectable EZ line, BCVA was significantly improved at as early as 1 month, whereas the remaining eyes exhibited visual improvements only at 3 months. Postoperative BCVA positively correlated with preoperative BCVA (r = 0.86, P < 0.005), and negatively correlated with SMH size (r = 0.69, P < 0.01) and PED height (r = 0.58, P < 0.05) and width (r = 0.67, P < 0.05). Multivariate analyses confirmed preoperative BCVA as the predominant factor associated with postoperative BCVA (β = 1.093, P < 0.05). In conclusion, significant improvements in BCVA and anatomical findings can be achieved with our reported surgical technique. Preoperative OCT findings may influence the duration required for visual improvements.

The need for Stroke code and Thrombectomy in Pakistan.

Stroke is one of the oldest studied medical illnesses, but it remains the second leading cause of mortality worldwide. The yearly mortality rate is over 5.5 million (1). However, in Pakistan, the estimated annual incidence of stroke is 250/100,000 or 350,000 cases; with the bulk occurring in the middle-aged. Due to a lack of information about the illness and its treatment choices, hundreds of individuals die each year, and an even more significant number live with a lifelong disability (2). If determined to be ischemic, stroke is treated immediately with an intravenous injection of recombinant tissue plasminogen activator, r-tPA, which is the standard gold treatment, according to guidelines, as long as the patients are transferred to a stroke unit within 4.5 hours. Thrombectomy, stents, surgery, and other medicines are also used (1). ---Continue

Pars plana vitrectomy and subretinal tissue plasminogen activator for large exudative submacular hemorrhage: a case series

BackgroundTo evaluate anatomical and functional outcomes of patients with large submacular hemorrhage (SMH) who treated by pars plana vitrectomy (PPV) in combination with subretinal tissue plasminogen activator (TPA) injection, intraocular gas tamponade, and with additional post-operative interventions.MethodsMedical records of 9 patients who presented with large SMH secondary to age-related macular degeneration (AMD) and underwent PPV, subretinal TPA injection, and gas tamponade at Chiang Mai university hospital between January 2012 and January 2020 were reviewed. Collected data included preoperative visual acuity (VA), SMH extent and duration, intraoperation and post-operation complications, post-operative anatomical and VA responses, and the need for administer post-operation additional treatments.ResultsOverall, five patients were male and four patients were female with a mean (SD) age of 66.9 (7.7) years and a mean (SD) follow-up of 21.1 (16.1) months. A mean (SD) duration of SMH was 15.1 (10.9) days with a mean (SD) extent of SMH was 6.2 (3.4) disc diameters. At 1-month post-operation, complete SMH displacement was noted in eight (88.9%) patients. The mean (SD) VA significantly improved from LogMAR 1.9 (0.4) to 1.1 (0.4), (P = 0.004). During follow-up, eight patients (88.9%) were given additional therapy (anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy, or in combination). At final follow-up, a mean (SD) LogMAR VA of 0.9 (0.4) was significantly improved compared to baseline (P = 0.004). For intra- and post-operation complications, none developed intraoperative retinal break and retinal detachment.ConclusionsVitrectomy with subretinal TPA injection, intraocular gas tamponade, and additional post-operation treatments provide benefit for anatomical and visual outcomes for patients with large SMH. It may consider as one of effective treatment in this group of patients.

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

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.

The outcomes of mechanical thrombectomy in patients with acute stroke with and without intravenous injection of tissue plasminogen activator

Background: Stroke is a major health problem and leading cause of mortality worldwide. This study aimed to evaluate the consequences of intravascular interventions in patients with acute ischemic stroke with and without intravenous tissue plasminogen activator (tPA) injection. Methods: This prospective cohort study was conducted on 120 patients with acute ischemic stroke. Patients were divided into three groups based on the type of disease treatment: angiography, tPA, and combined therapy (angiography + tPA). Patients in the tPA group were treated with a standard dose of intravenous alteplase (0.9 mg/kg). The severity of acute ischemic stroke was calculated on days 0, 14, and 90 after the interventions using the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) questionnaires. Results: All three groups were homogeneous regarding age, gender, location, job status, education, and body mass index (BMI) distribution. Coronary disease was the most common risk factor for stroke in 38.33% of patients. There was no significant difference in mean NIHSS and mRS scores between the groups on days 0, 14, and 90 after intervention (p &gt; 0.05). Mean NIHSS and mRS scores significantly decreased from the first time point (day 0), 10 days until 90 days after treatment in all three groups (p &lt; 0.001); however, there was no significant difference in treatment effect between the three groups at these time points (p &gt; 0.05). Conclusion: Treatment with angiography and tPA alone or with combined therapy significantly decreased the severity of acute ischemic stroke. A significant decrease was observed in the mean NIHSS and mRS scores in all therapy groups, indicating that these treatments were effective in mitigating acute ischemic stroke and improving functional independence in these patients. The eligibility criteria by which patients with acute ischemic stroke are selected for each specific therapy are essential to achieving better clinical outcomes.