INTRAOPERATIVE FIBRINOLYSIS OF SUBMACULAR HEMORRHAGE WITH TISSUE-PLASMINOGEN ACTIVATOR AND SURGICAL DRAINAGE

PUROSE: This pilot study determined the safety and efficacy of intraoperative pharmacologic lysis of recent submacular hemorrhage with tissue plasminogen activator followed by surgical drainage of the unclotted blood in patients with age-related macular degeneration. METHODS: In a prospective study, 24 consecutive eyes with recent (<14 days old) submacular hemorrhage secondary to age-related macular degeneration and good visual acuity before development of submacular hemorrhage were treated with vitrectomy, subretinal injection of tissue plasminogen activator, and removal of the liquefied blood. Patients were followed up for at least six months (mean, 14 months). RESULTS: Twenty eyes (83%) had improved visual acuity after surgery, and eight eyes (33%) attained visual acuity of 20/200 or better. In a subset of 16 eyes with submacular hemorrhage of seven days duration or less, eight (50%) attained visual acuity of 20/200 or better. Factors associated with poor visual outcome included submacular hemorrhage with duration greater than seven days (P < .001), the presence of hemorrhagic pigment epithelial detachment (P = .04), and massive subretinal hemorrhage (P = .04). CONCLUSIONS: Tissue plasminogen activator thrombolysis may be a valuable adjunct to the surgical treatment of select patients with submacular hemorrhages secondary to age-related macular degeneration.