Intravitreal tissue plasminogen activator and gas in submacular hemorrhage

Efficacy and complications of intravitreally injected tissue plasminogen activator (rt-PA) and sulfahexafluoride gas (SF6) in submacular hemorrhage are demonstrated. Patients and methods: Fifty-three patients with submacular hemorrhage were treated (27 women, 26 men, mean age 79 +/- 1 years). Causes of hemorrhage were a choroidal neovascularization in 47 patients and macroaneurysm in 6 patients. After i.v. administration of 500 mg acetazolamide and disinfection of the conjunctiva, 50 mu g rt-PA in 0.1 mi (BSS) and 0.5 mi SF6 were injected intravitreally. The patient was positioned prone for 24 h. Results: In 23 patients with choroidal neovascularization visual acuity improved by 2 lines and more; in 12 patients Vision remained unchanged. In 12 patients visual acuity deteriorated. In 5 of 6 patients with a macroaneurysm vision improved from less than 0.1 to 0.1-0.5. Postoperative complications were four cases of vitreous hemorrhage and one case of endophthalmitis. Conclusion: The intravitreal injection of rt-PA and SF6 is an alternative method for treatment of submacular hemorrhage.