Efrat Fleissig1,2, Adiel Barak3,4, Michaela Goldstein3,4, Anat Loewenstein3,4, Shulamit Schwartz3,4. 1. Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weitzman St., Tel Aviv, Israel, 6423906. efratbukelman@gmail.com. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. efratbukelman@gmail.com. 3. Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weitzman St., Tel Aviv, Israel, 6423906. 4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
PURPOSE: The purpose of this study was to evaluate the efficacy and visual outcome of massive submacular hemorrhage (SMH) displacement with a planned two-step pars plana vitrectomy (PPV) using tissue plasminogen activator (tPA) and perfluorocarbon liquid (PFCL) tamponade. METHODS: A retrospective case series of patients with age related macular degeneration and SMH was used. All patients underwent a 23G PPV, subretinal tPA injection and a medium term PFCL tamponade. A second stage PPV for PFCL removal was performed 7-17 days later. The main outcome was the change in macular and sub-RPE thickness after 6 months. Secondary outcomes were visual acuity and complications. RESULTS: Seven patients (seven eyes) with mean age of 79.85 years were enrolled. The average SMH size was 17.5 disc area (range 4.5-33) with mean symptoms of a duration of 9.5 days (range: 2-21). SMH was successfully displaced in six eyes. Mean macular and sub-RPE thickness decreased from 1505μ to 711.3μ and 900 μ to 457μ, respectively. Visual acuity (VA) remained stable in five eyes. Complications included corneal edema and transient intraocular pressure elevation in three patients. CONCLUSIONS: SMH displacement using subretinal tPA injection and medium term PFCL tamponade is an effective alternative treatment option. In our experience, it can be safely performed, avoiding complications commonly attributed to other techniques.
PURPOSE: The purpose of this study was to evaluate the efficacy and visual outcome of massive submacular hemorrhage (SMH) displacement with a planned two-step pars plana vitrectomy (PPV) using tissue plasminogen activator (tPA) and perfluorocarbon liquid (PFCL) tamponade. METHODS: A retrospective case series of patients with age related macular degeneration and SMH was used. All patients underwent a 23G PPV, subretinal tPA injection and a medium term PFCL tamponade. A second stage PPV for PFCL removal was performed 7-17 days later. The main outcome was the change in macular and sub-RPE thickness after 6 months. Secondary outcomes were visual acuity and complications. RESULTS: Seven patients (seven eyes) with mean age of 79.85 years were enrolled. The average SMH size was 17.5 disc area (range 4.5-33) with mean symptoms of a duration of 9.5 days (range: 2-21). SMH was successfully displaced in six eyes. Mean macular and sub-RPE thickness decreased from 1505μ to 711.3μ and 900 μ to 457μ, respectively. Visual acuity (VA) remained stable in five eyes. Complications included corneal edema and transient intraocular pressure elevation in three patients. CONCLUSIONS:SMH displacement using subretinal tPA injection and medium term PFCL tamponade is an effective alternative treatment option. In our experience, it can be safely performed, avoiding complications commonly attributed to other techniques.
Authors: Han Joo Cho; Kyoung Min Koh; Jae Hui Kim; Hyoung Seok Kim; Jung Il Han; Young Ju Lew; Tae Gon Lee; Jong Woo Kim Journal: Retina Date: 2015-02 Impact factor: 4.256
Authors: Margaret A Chang; Diana V Do; Susan B Bressler; Sandra D Cassard; Emily W Gower; Neil M Bressler Journal: Retina Date: 2010-09 Impact factor: 4.256
Authors: Gary Shienbaum; Carlos Alexandre A Garcia Filho; Harry W Flynn; Renata Portella Nunes; William E Smiddy; Philip J Rosenfeld Journal: Am J Ophthalmol Date: 2013-03-07 Impact factor: 5.258
Authors: Jae Hui Kim; Chul Gu Kim; Dong Won Lee; Su Jin Yoo; Young Ju Lew; Han Joo Cho; Joo Yeon Kim; Seok Hyun Lee; Jong Woo Kim Journal: Graefes Arch Clin Exp Ophthalmol Date: 2019-11-18 Impact factor: 3.117