Journal List > J Korean Ophthalmol Soc > v.50(5) > 1008566

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



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.


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.


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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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