TISSUE-PLASMINOGEN ACTIVATOR IN THE SURGICAL-MANAGEMENT OF SUBRETINALHEMORRHAGE

We report three cases of the use of tissue plasminogen activator (TPA) to aid the surgical removal of subretinal haemorrhage. All patients h ad choroidal neovascular membranes secondary to age-related macular de generation. The technique involved infusing a sterile solution of TPA through a small retinotomy and irrigating out the dissolved clot. The visual acuity improved in the first patient from a preoperative 6/36 t o 6/18 five weeks after surgery, but subsequently deteriorated to 6/60 after six months from a new choroidal neovascular membrane (CNVM), re maining 6/60 at nine months after surgery. The second patient's visual acuity improved from count fingers to 6/24 three weeks after surgery, but subsequently deteriorated to 6/60 after four months from a new CN VM, remaining 6160 at nine months after surgery. The third patient's v isual acuity improved from count fingers to 6/36 and remains stable at 6/36, eight months after surgery. Although long-term prognosis remain s guarded, these early results suggest that TPA may have a role in the management of subretinal haemorrhage.