Vitrectomy-Assisted Intravitreal Tissue Plasminogen Activator and SF6 Gas Injection on Submacular Hemorrhage

ABSTRACT

PURPOSE: To evaluate the results of vitrectomy-assisted intravitreal tissue plasminogen activator (tPA) and SF6 gas injection in the treatment of submacular hemorrhage. METHODS: Thirty-one eyes of 30 consecutive patients with submacular hemorrhages undergoing vitrectomy with intravitreal tPA (50 microg/0.1 ml) and SF6 gas injection and completed 12 months of follow-up were evaluated. RESULTS: The mean duration of visual symptoms was 4.1 days. Submacular blood was completely displaced in all 31 eyes after surgery. The best corrected visual acuity (logMAR) improved to 0.56 +/- 0.46 at 12 months from 1.15 +/- 0.51 at baseline (P = 0.002). The most important factors related to visual acuity at the 12-month follow-up were the underlying etiology for the submacular hemorrhage and visual acuity 3 months after surgery (P = 0.003 and P = 0.000, respectively). The 12-month visual acuity was independent of age, gender, presence of vitreous hemorrhage, sub-ILM hemorrhage, baseline visual acuity, duration of symptoms, and the diameter of the submacular hemorrhage. No retinal detachment or re-submacular hemorrhage developed during the follow-up period. CONCLUSIONS: This surgical technique can effectively displace submacular hemorrhage without complications. The 3-month visual acuity appears to predict the 12-month visual acuity. The final visual acuity was associated with the primary etiology for the submacular hemorrhage.