Objective: To study the anatomic and visual outcomes of a surgical procedure in which tissue plasminogen activator and air are injected subretinally to displace massive submacular hemorrhages secondary to age-related macular degeneration.
Design: Prospective, consecutive, interventional case series.
Participants: Thirteen consecutive patients (13 eyes) with massive submacular hemorrhages secondary to age-related macular degeneration.
Intervention: The surgical procedure consisted of a 25-gauge vitrectomy and submacular injection of tissue plasminogen activator (25 μg) and 0.4 ml air with a microneedle having an outer diameter of 50 μm. The procedure was followed by having the patient remain in the prone position overnight.
Main outcome measures: Mean visual acuity change from baseline, mean central lesion thickness change from baseline, fluorescein angiography findings, and surgical complications.
Results: Total subfoveal blood displacement was achieved in all 13 eyes (100%). Central lesion thickness decreased from a mean baseline value of 867 μm to a mean value of 379 μm at 1 month after surgery. There was visual improvement in 11 eyes, no visual improvement in 1 eye, and poorer vision in 1 eye. The mean change in Early Treatment Diabetic Retinopathy Study letter score from baseline was 19.4 letters at 1 month (P = 0.006) and 23.3 letters at 3 months (P = 0.001). There was intraoperative macular hole formation.
Conclusions: Submacular air injection with a microneedle facilitates displacement of clots dissolved with tissue plasminogen activator with few complications and results in earlier visual improvement.
Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.