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Subretinal injection of recombinant tissue plasminogen activator for submacular hemorrhage associated with ruptured retinal arterial macroaneurysm

  • Retinal Disorders
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Abstract

Purpose

To evaluate the surgical outcomes of small-gauge vitrectomy with subretinal injection of recombinant tissue plasminogen activator (rt-PA) for a submacular hemorrhage caused by a ruptured retinal arterial macroaneurysm (RAM).

Methods

Non-comparative, consecutive case-series performed at two ophthalmological institutions. We examined 22 eyes of 22 patients with a submacular hemorrhage associated with a RAM but without a preretinal or sub-internal limiting membrane hemorrhage at the fovea. During 25-gauge vitrectomy, approximately 4000–8000 IU of rt-PA was injected subretinally, followed by the injection of air or 10 % sulfur hexafluoride as a tamponade. The patients maintained an upright position for 1 hour, then turned to a facedown position for 1 to 3 days. The best-corrected visual acuity (BCVA) and postoperative complications were evaluated.

Results

The average interval from the onset of symptoms to surgery was 8.4 ± 7.6 days, and the average size of the subretinal hemorrhage was 3.4 ± 1.0 disc diameters. The submacular hemorrhage was displaced from the foveal area in all eyes after 1 week. The mean baseline BCVA was 1.41 ± 0.41 logMAR units, and it improved to 0.91 ± 0.43 at 1 month and to 0.64 ± 0.45 at the final visit (P = 0.0001, P < 0.0001 respectively). A macular hole was detected intraoperatively in two eyes and postoperatively in two eyes, and both were closed by internal limiting membrane peeling or a second vitrectomy.

Conclusions

Small-gauge vitrectomy with subretinal rt-PA injection and gas tamponade were effective in displacing a submacular hemorrhage associated with a RAM.

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Acknowledgments

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony, or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Contributions of authors: Involved in data collection (MI, FS, YS, YM, SK). Involved in management, analysis, interpretation, and preparation of the data (MI, FS, YS). Involved in interpretation, and preparation of the manuscript (MI, FS, AH). The study and data accumulation were carried out with approval from the Institutional Review Board of the Kagawa University Faculty of Medicine, the Okayama University Medical School, and the Kyorin University School of Medicine, and conformed to the tenets of the Declaration of Helsinki. Informed consent for the research was obtained from all patients. Scientific writing assistance was provided by Professor Duco I. Hamasaki, PhD of Hamasaki Scientific Editing (Miami, FL, USA).

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Authors and Affiliations

  1. Kryorin Eye Center, Kryorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Makoto Inoue & Akito Hirakata

  2. Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Fumio Shiraga, Yuki Morizane & Shuhei Kimura

  3. Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan

    Yukari Shirakata

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  1. Makoto Inoue
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Correspondence to Makoto Inoue.

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Inoue, M., Shiraga, F., Shirakata, Y. et al. Subretinal injection of recombinant tissue plasminogen activator for submacular hemorrhage associated with ruptured retinal arterial macroaneurysm. Graefes Arch Clin Exp Ophthalmol 253, 1663–1669 (2015). https://doi.org/10.1007/s00417-014-2861-6

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  • DOI: https://doi.org/10.1007/s00417-014-2861-6

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