Pneumatic displacement of submacular hemorrhage with or without tissue plasminogen activator

Abstract

Purpose: To assess the efficacy and complications of intravitreal injection of sulfur hexafluoride (SF(6)) gas with/without tissue plasminogen activator (tPA) for displacing submacular hemorrhage.

Methods: The medical records of 53 eyes that underwent pneumatic displacement for submacular hemorrhage were reviewed retrospectively. Submacular hemorrhage was related to exudative age-related macular degeneration (AMD) in 39 eyes and ruptured retinal arterial macroaneurysms in 14 eyes, and treated with intravitreal injection of SF(6) gas with or without tPA.

Results: Compared with preoperatively (mean follow-up, 18.4 months), the final visual acuity (VA) improved by 0.3 or more logMAR unit in 34 eyes (64.2%), stabilized within 0.3 logMAR in 15 eyes (28.3%), and deteriorated in four eyes (7.5%). In eyes with AMD, hemorrhage including vitreous hemorrhage recurred in eight (22.2%) of 36 eyes treated with tPA and one (33.3%) of three eyes not treated with tPA. In eyes with macroaneurysms, hemorrhage recurred in four (100%) of four eyes treated with tPA and in one (10.0%) of ten eyes without tPA (p < 0.005). Eight eyes underwent vitrectomy for recurrent hemorrhage. During follow-up, photodynamic therapy or intravitreal ranibizumab or pegaptanib was administered in 16 (41.0%) of 39 eyes with AMD. Postoperative ocular hypertension persisting over 3 days was not observed.

Conclusions: Intravitreal SF(6) gas plus tPA may be well-accepted, with good visual outcomes and no remarkable complications for treating submacular hemorrhage secondary to AMD. tPA is not recommended for ruptured retinal arterial macroaneurysms, because of a higher incidence of subsequent vitreous hemorrhage. Pneumatic displacement of submacular hemorrhage without tPA may provide good visual outcomes with less re-bleeding.