SURGICAL REMOVAL OF SUBMACULAR HEMORRHAGE USING TISSUE-PLASMINOGEN ACTIVATOR AND PERFLUOROCARBON LIQUID

PURPOSE: To assess the result of surgical removal of submacular hemorr hage by using tissue plasminogen activator and perfluorocarbon liquid. METHODS: In 22 consecutive patients (22 eyes), subretinal hemorrhage associated with age-related macular degeneration, which involved the f ovea and completely obscured the choroidal vascular pattern, was treat ed by pars plana vitrectomy. The hemorrhages were liquefied with tissu e plasminogen activator, squeezed into the vitreous cavity with perflu orocarbon liquid, and then evacuated. RESULTS: Efficacy of the procedu re was judged by the best postoperative corrected visual acuity, which was 20/100 or better in 16 eyes (73%), Submacular hemorrhage recurred in four (18%) eyes, epiretinal membrane formed in three (14%) eyes, a nd retinal detachment occurred in three (5%) eyes. Best corrected fina l visual acuity was improved postoperatively in 18 (82%) of the 22 eye s, unchanged in three (14 %) eyes, and decreased in one (5%) eye. Fina l visual acuity was 20/200 or better in 15 eyes (68%) and limited in o ther eyes by subretinal hemorrhage of greater than 30 days' duration o r subfoveal neovascularizations.CONCLUSIONS: Use of tissue plasminogen activator and perfluorocarbon liquid in surgical removal of submacula r hemorrhage may improve the outcome of surgery by reducing surgically induced retinal damage.