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

Jong Ho Kim; Jun Hyuk Son; Woo Hyok Chang

doi:10.3341/jkos.2008.49.2.267

Journal List > J Korean Ophthalmol Soc > v.49(2) > 1008183

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Kim, Son, and Chang: Intravitreal Injection of tPA and Gas for Submacular Hemorrhage Associated with Age-related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2008;49(2):267-273.

Published online: 31 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.2.267

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

Jong Ho Kim, M.D., Jun Hyuk Son, M.D., Woo Hyok Chang, M.D.

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Woo Hyok Chang, M.D., Department of Ophthalmology, Yeungnam University Hospital #317-1 Daemyung 5-dong, Nam-gu, Daegu 705-717, Korea Tel: 82-53-620-3443, Fax: 82-53-626-5936, E-mail: changwh@yumail.ac.kr

Received 5 February 2007 Accepted 21 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 C₃ F₈ 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.

Keywords: Age-related macular degeneration, Submacular hemorrhage, Tissue plasminogen activator

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Figure 1.

Fundus photograph of Patient 2 (66/M) (A) Preoperative fundus photograph shows wide blood clot covering the fovea.(B) 4-week postoperative fundus photograph demonstrates typical displacement of blood inferotemporal to the fovea.

Figure 2.

Fundus photograph of Patient 5 (67/M) (A) Submacular hemorrhage involving the fovea center shown before surgery. (B) Corresponding preoperative fluorescein angiogram. (C) Submacular hemorrhage completely displaced from the fovea 2 weeks after surgery. (D) Corresponding postoperative fluorescein angiogram showing juxtafoveal choroidal neovascular membrane.

Figure 3.

Initial visual acuity versus final visual acuity. Eyes experiencing visual improvement fall above the oblique line.

Table 1.

Patient data

Patient No./ Sex/Age/Eye	Diagnosis	Displacement of hemorrhage	Hemorrhage		Visual Acuity			Follow-up (months)	Final macular status	Complications
Patient No./ Sex/Age/Eye	Diagnosis	Displacement of hemorrhage	Duration (days)	Diameter (DD)	r Initial	Best	Final	Follow-up (months)	Final macular status	Complications
1/F/63/OD	AMD	complete	8	10	HM^*	0.4	0.4	17	Juxtafoveal CNV^†
2/M/67/OS	AMD	complete	4	9	0.06	0.3	0.2	21	Subfoveal CNV
3/F/82/OS	AMD	partial	10	7	0.04	0.01	0.01	22	Subfoveal CNV	VH^‡
4/F/64/OD	AMD	complete	11	3	0.02	0.08	0.08	23	Subfoveal CNV
5/M/66/OS	AMD	partial	6	2	0.3	0.6	0.6	10	Juxtafoveal CNV
6/M/66/OS	AMD	partial	10	4	0.3	0.3	0.3	15	Subfoveal CNV
7/M/63/OS	AMD	complete	5	2	0.1	0.5	0.5	12	Juxtafoveal CNV
8/M/57/OS	AMD	complete	6	6	0.4	0.7	0.7	19	Subfoveal CNV
9/F/80/OD	AMD	partial	2	5	0.02	HM	HM	18	Subfoveal CNV	VH
10/F/77/OD	AMD	complete	14	3	HM	HM	HM	6	Subfoveal CNV
11/F/65/OS	AMD	complete	7	4	0.3	0.4	0.4	7	Juxtafoveal CNV

^* HM=hand motion

^† CNV=choroidal neovascularization

^‡ VH=vitreous hemorrhage.

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