Retinal Toxicity of Intravitreal Tissue Plasminogen Activator on Submacular Hemorrhage

ABSTRACT

PURPOSE:To present the clinical feature of retinal toxicity of intravitreal tissue plasminogen activator which was used for treatment of submacular hemorrhage. CASE SUMMARY: An intravitreal injection of tPA (100 microg) with C3F8 gas tamponade (0.2 cc) was given to treat the submacular hemorrhage in a patient with ARMD. The therapeutic effect was measured by visual acuity, slit lamp examination, indirect funduscopy and fluorescein angiogram. Three months after the operation, the hemorrhage was decreased but a pigmentary change was observed on the peripheral retina. After 8 months, the submacular hemorrhage completely reabsorbed but the peripheral pigmentary change had increased. Ten months later, the retinal pigmentary change was observed on the entire retina except the posterior pole. The fluorescein angiogram showed peripheral hyperfluorescene of the retina due to window defect from the pigmentary change but no leakage was detected. The electroretinogram showed reduced amplitude in the right eye. CONCLUSIONS: Intravitreal tPA injection of 25 to 100 microg with pneumatic displacement is typically used for the treatment of submacular hemorrhage. However, there is no established safety dose of tPA for use in human eyes. In the present study, 100 microg of tPA was used and retinal toxicity was noted. Establishing a safety dose of tPA to prevent dosage dependent complications is necessary.