Retinal pigment epithelial tear after subretinal rtpa and intravitreal air for the displacement of a large submacular hemorrhage.

PURPOSE: The authors report a case of retinal pigment epithelial (RPE) tear following pars plana vitrectomy (PPV), subretinal recombinant tissue plasminogen activator (rt-PA), and intravitreal gas administration for the displacement of large submacular hemorrhage.
METHODS: A patient with a large submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD) received a subretinal rt-PA injection and intravitreal air installation after PPV. Ophthalmic examination included standardized visual acuity testing and fluorescein angiography. PATIENTS: One patient from the authors' outpatient clinic.
RESULTS: Baseline visual acuity of the eye was 20/160. Ophthalmoscopy showed a predominantly hemorrhagic lesion in the macula. Ophthalmoscopy and fluorescein angiography 2 weeks after the surgery revealed a RPE tear. Postoperative visual acuity was 20/1000.
CONCLUSIONS: This case demonstrates that a RPE tear is a possible complication of the procedure of subretinal rt-PA and intravitreal air tamponade after PPV for the displacement of a large submacular hemorrhage secondary to neovascular AMD. The surgeon has to be aware about this complication and should inform the patient before surgery.