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.
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.
Authors: A S Hassan; M W Johnson; T E Schneiderman; C D Regillo; P E Tornambe; L S Poliner; B A Blodi; S G Elner Journal: Ophthalmology Date: 1999-10 Impact factor: 12.079
Authors: Michael M Altaweel; Ebenezer Daniel; Daniel F Martin; Robert A Mittra; Juan E Grunwald; Michael M Lai; Alexander Melamud; Lawrence S Morse; Jiayan Huang; Frederick L Ferris; Stuart L Fine; Maureen G Maguire Journal: Ophthalmology Date: 2014-10-11 Impact factor: 12.079