Retinal Toxicity of Intravitreal Tissue Plasminogen Activator on Submacular Hemorrhage

Jong Jin Jung; Sung Won Cho

doi:10.3341/jkos.2009.50.5.800

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Jung and Cho: Retinal Toxicity of Intravitreal Tissue Plasminogen Activator on Submacular Hemorrhage

Original Article

J Korean Ophthalmol Soc 2009;50(5):800-803.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.5.800

Retinal Toxicity of Intravitreal Tissue Plasminogen Activator on Submacular Hemorrhage

Jong Jin Jung, MD, Sung Won Cho, MD

Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University, Seoul, Korea

Address reprint requests to Sung Won Cho, MD Department of Opthalmology, Kim's Eye Hospital #156 4-ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul 150-034, Korea Tel: 82-2-2639-7777, Fax: 82-2-2639-7824, E-mail: eyecure@kimeye.com

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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 present the clinical feature of retinal toxicity of intravitreal tissue plasminogen activator which was used for treatment of submacular hemorrhage.

Case summary

An intravitreal injection of tPA (100 μ g) with C₃ F₈ gas tamponade (0.2 cc) was given to treat the submacular hemorrhage in a patient with ARMD. The therapeutic effect was measured by visual acuity, slit lamp examination, indirect funduscopy and fluorescein angiogram. Three months after the operation, the hemorrhage was decreased but a pigmentary change was observed on the peripheral retina. After 8 months, the submacular hemorrhage completely reabsorbed but the peripheral pigmentary change had increased. Ten months later, the retinal pigmentary change was observed on the entire retina except the posterior pole. The fluorescein angiogram showed peripheral hyperfluorescene of the retina due to window defect from the pigmentary change but no leakage was detected. The electroretinogram showed reduced amplitude in the right eye.

Conclusions

Intravitreal tPA injection of 25 to 100 μ g with pneumatic displacement is typically used for the treatment of submacular hemorrhage. However, there is no established safety dose of tPA for use in human eyes. In the present study, 100 μ g of tPA was used and retinal toxicity was noted. Establishing a safety dose of tPA to prevent dosage dependent complications is necessary.

Keywords: ARMD, Retinal toxicity, Submacular hemorrhage, tPA

References

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Figure 1.

Preoperative fundus photograph and fluorescein angiogram show large submacular hemorrhage (about 4.5DD) occupying the posterior pole extending inferiorly outside the major arcade.

Figure 2.

Three months after intravitreal tPA and gas injection. The submacular hemorrhage was largely absorbed and peripheral pigmentary change was noted.

Figure 3.

(A, B) After ten month, the submacular hemorrhage was absolutely absorbed. Pigmentary change was noted in the whole retina except in the posterior pole. (C, D) Fluorescein angiogram shows hyperfluorescene of the retina.

Figure 4.

Scotopic electroretinogram showed a prolonged implict time and reduced amplitude of the B-wave and photopic ERG showed a prolonged implict time with decreased amplitude of both A-wave and B-wave in the right eye.

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