J Korean Ophthalmol Soc.  1996 Jul;37(7):1139-1148.

Early Evacuation of Massive Subretinal Hemorrhage with Low-dose Tissue Plasminogen Activator

• Choi MY
• Kang SW

Abstract

Massive subretinal hemorrhage may develop secondary to choroidal neovascularization. The poor visual prognosis associated with submacular hemorrhage can be explained by preexisting abnormality of photoreceptorretinal pigment epithelium-Bruch's membrane complex and fibrin-mediated injury to the outer segment of photoreceptor. An animal experiment showed that subretinal fibrin induced irreversible damage to the retina within 24 hours. We use recombinant tissue plasminogen activator(rt-PA), at doses(3 microgram substantially lower than previously reported, to aid in the surgical evacuation of massive subretinal hemorrhage within 2 days of its development. The subretinal hemorrhage in both patients developed in association with age-related macular degeneration. Postoperative corrected visual acuity improved from counting fingers to 0.3 in one patient and from hand motion to 0.04 in the other. There has been no complication except ocular hypertension which is medically controllable. Subfoveal neovascularization explains poor postoperative vision in one case. It seems that visual recovery is facilitated by early evacuation of massive subretinal hemorrhage and by using low-dose rt-PA. Low-dose rt-PA may minimize the risks of intraocular hemorrhage and retinal toxicity.

Keyword

Early removal; Sub retinal hemorrhage; Tissue plasminogen activator

MeSH Terms

Animal Experimentation
Choroidal Neovascularization
Fibrin
Fingers
Hand
Hemorrhage*
Humans
Macular Degeneration
Membranes
Ocular Hypertension
Plasminogen
Prognosis
Retina
Retinaldehyde
Tissue Plasminogen Activator*
Visual Acuity
Fibrin
Plasminogen
Retinaldehyde
Tissue Plasminogen Activator