Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas

Graefes Arch Clin Exp Ophthalmol. 1999 Apr;237(4):273-7. doi: 10.1007/s004170050232.


Purpose: To assess the effects of intravitreal injection of recombinant tissue plasminogen activator (rTPA) and gas on submacular hemorrhage in age-related macular degeneration (ARMD).

Methods: Eleven consecutive patients (11 eyes) with subretinal hemorrhage due to ARMD involving the fovea with elevation of the neurosensory retina were included in this study. Subretinal hemorrhage occured 12 h to 14 days before onset of therapy. Injection of rTPA through the pars plana in a dose of 50 or 100 microg was performed. Gas instillation (0.2-0.4 ml) followed rTPA injection, either immediately after injection (7 patients) or during the following day (4 patients).

Results: After intravitreal injection of rTPA, subretinal clots were totally or partially liquefied when treatment started up to 3 days after onset of bleeding. In all patients treated with 100 microg rTPA a large exudative retinal detachment of the inferior retina resulted, which reabsorbed spontaneously within 2 weeks. After reattachment of the exudative retinal detachment hyperpigmentation of the retinal pigment epithelium was noted. Temporary opacification of the vitreous was observed between the 2nd and 7th postoperative day in 5 eyes (45.5%). Postoperative visual acuity increased in 5 patients (45.5%).

Conclusion: Intravitreal application of rTPA followed by gas injection is a sufficient and convenient technique for effective removal of freshly formed submacular hemorrhage. Removal is mediated through combined enzymatic (rTPA) and mechanical (gas) effects. This technique offers a quick recovery of vision in eyes with less severe ARMD.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Electroretinography
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use*
  • Fluorescein Angiography
  • Fluorocarbons / administration & dosage
  • Fluorocarbons / therapeutic use*
  • Follow-Up Studies
  • Fundus Oculi
  • Humans
  • Injections
  • Macular Degeneration / complications
  • Male
  • Middle Aged
  • Recombinant Proteins
  • Retinal Hemorrhage / diagnosis
  • Retinal Hemorrhage / drug therapy*
  • Retinal Hemorrhage / etiology
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome
  • Vitreous Body


  • Fibrinolytic Agents
  • Fluorocarbons
  • Recombinant Proteins
  • perflutren
  • Tissue Plasminogen Activator