Subretinal alteplase injections in massive subretinal hemorrhage due to age‑related macular degeneration: A case report series

Abstract

This report describes a series of cases with massive subretinal hemorrhage (SRH) due to age-related macular degeneration (AMD) treated by subretinal alteplase injections. In all cases, the surgical technique consisted in 25-gauge pars plana vitrectomy (PPV) and alteplase injection under the retina using a 38-gauge cannula. After the fluid-gas exchange, bevacizumab injection was performed in all patients. Three cases of SRH in which this technique was used, as well as their evolution at one week and one month postoperatively are described. Visual acuity was hand motion in all three cases at presentation. After surgery, a significant anatomical and functional improvement was noted in all cases. One month postoperatively, none of the patients had blood under the macula, and visual acuities significantly improved to 0.8, 0.2 and 0.16 (decimal fraction). A consistent reduction of central retinal thickness was observed on optical coherence tomography (OCT) from the first week postoperatively. No intra and postoperative complications were noted. Subretinal alteplase injection proved as a viable solution in these severe SRH with early presentation. There was no need to change the systemic anticoagulant and antiaggregant therapy. Bevacizumab intravitreal injection at the end of surgery has an important role in preventing further bleeding.

Management of submacular massive haemorrhage in age‐related macular degeneration: comparison between subretinal transplant of human amniotic membrane and subretinal injection of tissue plasminogen activator

“…We have to cope with different invasiveness and duration of the two interventions, besides considering the second surgery time to remove SO in hAM-group. Nowadays, due to its apparent easiness compared with transplantation techniques, tPA injection in massive macular haemorrhage has become widely used (Ochinciuc et al 2020). Nevertheless, the higher correlation between time of surgery and the onset symptoms with functional restoration in the tPA-group could address the choice of the surgery with the time passed of onset symptoms.…”

“…The latter technique appears to be less suitable for massive bleeding compared with other surgeries, such as retinal pigmented epithelium (RPE) patch transplant. Nowadays, the current approach seems to be towards a major use of tPA injection in massive haemorrhage too, as shown in literature (Ochinciuc et al 2020).…”

“…Nowadays, the current approach seems to be towards a major use of tPA injection in massive haemorrhage too, as shown in literature (Ochinciuc et al. 2020).…”

Surgical Treatment in Silicone Oil-Associated Glaucoma

“…IOP may be difficult to measure, because of an altered corneal status, as is also the case in anterior segment pathology or after corneal surgery [11][12][13][14]. Moreover, decreased visual acuity with associated impaired fixation may preclude IOP measurement, similarly to ocular media opacities and advanced macular disease [15][16][17]. What is more, a correct evaluation of the optic nerve is not always possible due to poor fixation and difficult visualization of the retina.…”