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    The effect of subretinal recombinant tissue plasminogen activator application for submacular hemorrhage
    (Gazi Eye Foundation, 2024) Ozer, Omer; Dinc, Erdem; Dursun, Ozer; Yilmaz, Emre Can; Turkmen, Ismail; Eroz, Pinar
    Purpose: The aim of the present study was to evaluate the outcomes of subretinal tissue plasminogen activator (r-tPA) injection with pars plana vitrectomy (PPV) in patients with submacular hemorrhage (SMH) extending towards the fovea. Materials and Methods: The study included 10 eyes of 10 patients who underwent subretinal r-tPA injection with 23 G PPV due to SMH extending towards the fovea. Following standard 23 G PPV, r-tPA (Actilyse, 10 mg/mL, Boehringer-Ingelheim, Germany) at a concentration of 25 µg/0.1 ml was injected into the subretinal space with a 41 G needle at a concentration of 0.2-0.3 ml. Subsequently, fluid-air-12% C3F8 exchange was performed and intravitreal 1.25 mg bevacizumab was administered. After surgery, the patient was given appropriate head position according to the bleeding site. Results: The mean age of the patients was 73.9 ± 4.7 years, 4 (40%) were male and 6 (60%) were female. Two patients (20%) developed SMH due to retinal macroaneurysm rupture, while choroidal neovascular membrane was the cause of hemorrhage in 8 patients (80%). Best corrected visual acuity was 2.53 ± 0.49 logMAR preoperatively, 1.28 ± 0.66 at one month, 1.08 ± 0.64 at three months and 1.04 ± 0.62 at six months postoperatively and the difference was significant (p<0.001 for each parameter). Conclusions: In patients with submacular hemorrhage, r-tPA administered subretinally provides significant visual acuity improvement without serious complications. Copyright © 2024 The author(s).