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Recombinant tissue plasminogen activator, vitrectomy, and gas for recent submacular hemorrhage displacement due to retinal macroaneurysm

  • Retinal Disorders
  • Published:
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Abstract

Background

The visual prognosis of submacular hemorrhages caused by a retinal arterial macroaneurysm (RAM) is poor if left untreated. The use of recombinant tissue plasminogen activator (rtPA) has frequently been reported to displace submacular hemorrhages from the foveal area in patients with age-related macular degeneration. This study aims to investigate the results of displacement of recent-onset submacular hemorrhages due to RAM.

Methods

Institutional retrospective interventional case series of 12 patients with macular hemorrhage due to RAM, who underwent pars plana vitrectomy (PPV); followed in 11 by submacular injection of rtPA and gas tamponade. The main outcome measures were displacement of the hemorrhage, complication rate, and visual acuity at 1 month after surgery and at the last follow-up visit.

Results

One month after surgery, the hemorrhage had been successfully displaced in ten out of 11 patients. In these ten patients, visual acuity (VA) increased by a mean of 1.2 logMAR at 1 month after surgery. At the last follow-up visit, the mean increase was 1.5 logMAR. Complications consisted of a vitreous hemorrhage and hyphema, retinal detachment, a new submacular hemorrhage, and vitreous hemorrhage after argon laser retinal photocoagulation of the RAM.

Conclusions

PPV with submacular rtPA and gas injection may successfully displace a recently developed submacular hemorrhage in patients with RAM, with a marked improvement in VA that is likely to be greater than if left untreated.

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Acknowledgments

We would like to thank L. Spielberg (The Rotterdam Eye Hospital) for manuscript editing.

Funding/Support

1) The Rotterdam Eye Hospital Flieringa Research Foundation, Rotterdam, The Netherlands

2) Royal Visio, Rotterdam, The Netherlands

Financial disclosure

The last author J.C. van Meurs is the partial owner of a patent: vibration device for tissue release, with Dutch Ophthalmic Research Center [DORC], Zuidland, The Netherlands, one prototype. The other authors have no financial disclosures.

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Authors and Affiliations

  1. The Rotterdam Ophthalmic Institute, Schiedamse Vest 160-D, 3011 BH, Rotterdam, The Netherlands

    Elsbeth J. T. van Zeeburg

  2. The Rotterdam Eye Hospital, PO Box 70030, 3000 LM, Rotterdam, The Netherlands

    Elsbeth J. T. van Zeeburg, Matteo G. Cereda & Jan C. van Meurs

  3. Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Jan C. van Meurs

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  1. Elsbeth J. T. van Zeeburg
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  2. Matteo G. Cereda
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  3. Jan C. van Meurs
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Correspondence to Elsbeth J. T. van Zeeburg.

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All authors have full control of all primary data and agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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van Zeeburg, E.J.T., Cereda, M.G. & van Meurs, J.C. Recombinant tissue plasminogen activator, vitrectomy, and gas for recent submacular hemorrhage displacement due to retinal macroaneurysm. Graefes Arch Clin Exp Ophthalmol 251, 733–740 (2013). https://doi.org/10.1007/s00417-012-2116-3

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  • DOI: https://doi.org/10.1007/s00417-012-2116-3

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