PNEUMATIC DISPLACEMENT OF SUBMACULAR BLOOD AFTER VITRECTOMY AND SUBRETINAL RTPA INJECTION

Carl Awh (Nashville)

Purpose: To evaluate the anatomic and visual outcome following pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (tPA) injection, and fluid-air exchange (FAX) in patients with thick submacular hemorrhage (SMH) secondary to age-related macular degeneration (AMD).

Methods: A consecutive series of 10 eyes of 10 patients with decreased vision due to SMH and AMD were treated with PPV, subretinal injection of 25 to 75 micrograms of tPA in 0.2 to 0.3 cc of solution, and FAX. Pre-operative duration of SMH ranged from 2 to greater than 60 days (mean 17). The tPA solution was injected beneath the macula using a flexible subretinal microcannula. Post-operatively, patients remained in the supine position for 1 hour from the time of injection of the tPA, and were then instructed to maintain a face downward position for 24 hours. Pre- and post-operative Snellen visual acuities, fundus photographs, and fluorescein angiograms (FA) were obtained.

Results: Vision improved in 8 eyes and remained stable in 2 eyes at follow-up 2 to 14 months after surgery. There were no surgical complications, and no adverse effects related to the tPA. Post-operative FA revealed occult CNV in 6 eyes, classic CNV in 2 eyes, and inactive scars in 2 eyes.

Conclusions: SMH secondary to AMD can be effectively and safely displaced by this technique, which ensures the delivery of tPA to the subretinal space, creates a potential space for movement of liquefied blood, and minimizes operating room time. Visual outcomes may be similar to or better than those achieved by reported alternative techniques. Identification of the source of SMH allows subsequent treatment with evolving new therapies


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