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Massive subretinal and subretinal pigment epithelial hemorrhage displacement with perfluorocarbon liquid using a two-step vitrectomy technique

  • Retinal Disorders
  • Published:
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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.

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Authors and Affiliations

  1. Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weitzman St., Tel Aviv, Israel, 6423906

    Efrat Fleissig, Adiel Barak, Michaela Goldstein, Anat Loewenstein & Shulamit Schwartz

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Efrat Fleissig, Adiel Barak, Michaela Goldstein, Anat Loewenstein & Shulamit Schwartz

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  1. Efrat Fleissig
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  2. Adiel Barak
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  4. Anat Loewenstein
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Correspondence to Efrat Fleissig.

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No additional funding was received for this project.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board which adhered to the tenets of the Declaration of Helsinki. For this type of study formal consent is not required.

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Fleissig, E., Barak, A., Goldstein, M. et al. Massive subretinal and subretinal pigment epithelial hemorrhage displacement with perfluorocarbon liquid using a two-step vitrectomy technique. Graefes Arch Clin Exp Ophthalmol 255, 1341–1347 (2017). https://doi.org/10.1007/s00417-017-3648-3

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  • DOI: https://doi.org/10.1007/s00417-017-3648-3

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