Treatment of multilevel macular hemorrhage secondary to retinal arterial macroaneurysm with submacular tissue plasminogen activator

Abstract

Purpose.

To evaluate the efficacy of pars plana vitrectomy (PPV) followed by internal limiting membrane (ILM) removal and injection of subretinal recombinant tissue plasminogen activator (rtPA)–assisted pneumatic displacement in eyes with massive multilevel macular hemorrhage caused by ruptured retinal arterial macroaneurysm (RAMA).

Methods.

Four eyes of 4 patients treated with PPV for recent (≤7 days) macular hemorrhage at both beneath the ILM and subretinal space involving the center of the fovea caused by RAMA were included in the study. In each case, following PPV, ILM removal, subretinal injection of rtPA (12.5 µg/0.1 mL), and fluid-air exchange with postoperative prone positioning was performed. Optical coherence tomography (OCT) examination was performed at the initial and the follow-up visits.

Results.

Duration of symptoms ranged from 3 to 7 days (average, 4.5±1.9 days). Preoperative visual acuity ranged from hand motions to 20/800. Follow-up ranged from 6 to 18 months (average, 13±5.2 months). The postoperative visual acuity improved in all eyes and ranged from 20/100 to 20/30 (mean, 20/50). At the final visit, OCT examination revealed well-preserved foveal structure in all eyes. Mild nuclear sclerosis developed in one eye.

Conclusions.

Pars plana vitrectomy followed by ILM removal and injection of subretinal rtPA-assisted pneumatic displacement appears to be effective in both improving visual acuity and preserving the foveal structure in eyes with recent massive multilevel macular hemorrhage secondary to RAMA.