Preoperative use of tissue plasminogen activator for large submacular hemorrhage

BACKGROUND AND OBJECTIVE: Tissue Plasminogen Activator (TPA) has been used as an adjunct in the surgical removal of submacular hemorrhage. It is usual ly used intraoperatively, but may not provide enough time for effective fib rinolysis, especially for a large hemorrhage. The present study was conduct ed to evaluate the efficiency and safety of preoperative use of TPA for lar ge submacular hemorrhages. METHODS: Five eyes with large submacular hemorrhage secondary to age-relate d macular degeneration underwent subretinal injection of TPA in the office 24 hours before surgery. All hemorrhages were less than seven days old and at least 3 mm thick. RESULTS: Preoperative visual acuity ranged from counting fingers to hand mo tion (HM). Patient follow-up ranged from 3 months to 24 months (mean, 11 mo nths). Final visual acuity ranged from 20/30 to HM. Four of the five eyes ( 80%) showed improved visual acuity after surgery and 3/5 (60%) attained vis ual acuity of 20/200 or better. CONCLUSION: Preoperative use of TPA for drainage of large submacular hemorr hage appears to be safe and may result in efficient dot removal. The true e fficacy of TPA in the treatment of submacular hemorrhage can only be proven by a prospective randomized trial.