Removal of Subretinal Hemorrhage Facilitated by Preoperative Intravitreal Tissue Plasminogen Activator

Intravitreal Tissue Plasminogen Activator, Perfluoropropane (C3f8), and Ranibizumab or Photodynamic Therapy for Submacular Hemorrhage Secondary to Wet Age-Related Macular Degeneration

“…In most reports, the TPA was injected into the subretinal space and then the subretinal blood was directly aspirated, although various techniques have been attempted. [31][32][33][34][35][36][37][38][39][40] There are also several reports using intravitreal TPA and gas without vitrectomy, or gas alone, but many of these studies occurred before the widespread introduction of anti-vascular endothelial growth factor therapy or PDT. 29,41 As such, the underlying disease remained untreated.…”

Management of Submacular Hemorrhage With Intravitreal Injection of Tissue Plasminogen Activator and Expansile Gas

“…Heriot proposed that the intravitreal tPA would enzymatically liquefy the submacular blood, which would then be pneumatically displaced inferiorly in the subretinal space without vitrectomy. 26 This technique was based on the clinical observation that suggested partial clot lysis occurred with preoperative and intraoperative intravitreal tPA injection 23,27 together with Heriot's clinical observation that the liquefied subretinal blood was often displaced inferiorly postoperatively by intravitreal gas. These observations were supported by both animal and clinical studies.…”

Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage

“…Although Kamei et al reported that intravitreal tPA did not diffuse into the subretinal spaces in normal rabbits, 21 there is much evidence that intravitreally injected tPA migrates across the pathologic retina. [22][23][24][25][26] Retina damaged by SRH, in contrast with a normal retina, might have microlesions allowing bidirectional diffusion; subretinal haemorrhage flows into the vitreous cavity and intravitreal tPA diffuses into the subretinal spaces and vice versa. 13 23 In humans, injection of 50 mg tPA seems to be sufficient for haemolysis, causing an inferior shift of the SRH in a gravity-dependent manner.…”