1M.D. Assistant Professor Sardar Bahadur Dr Sohan Singh Eye Clinic, AMRITSAR/HINDISTAN 2M.D. Professor Sardar Bahadur Dr Sohan Singh Eye Clinic, AMRITSAR/HINDISTAN
Purpose: To evaluate the clinical outcome in terms of anatomical displacement of sub macular hemorrhage(SMH) and visual outcomes of
intravitreal tissue plasminogen activator (tPA) and expansile gas Sulfur hexafluoride(SF6) injection as a minimally invasive treatment for
SMH of duration one week or less .
Design: Retrospective non-comparative interventional case series.
Materials and Methods: This study was a retrospective clinical case series examining 44 eyes that received an intravitreal injection of 100
mcg of tPA and SF6 for SMH. The main outcomes evaluated were visual acuities (VA), anatomic displacement of sub macular blood, and complications.
Results: Age related macular degeneration was the etiological diagnosis in 38.5% eyes followed by trauma in 27%.Comparison of
SMH size on pretreatment versus on first week follow up revealed reduction of size in majority from 2 disc diameters pretreatment in 38.6%
eyes to 1 disc diameter post-treatment in 59.1% eyes. However the shifting of the SMH was observed in all cases. This was seen translating into
visual gain with 31.8% eyes gaining 1-2 Snellen lines, 18.2 % gaining 2-3 lines and 13.5 % gaining 3-5 lines. Major complication was noted
in 2 cases (Rebleed and break-through vitreous hemorrhage in one each).
Conclusion: Intravitreous injection of tPA and gas, followed by a brief period of prone positioning, is effective in displacing thick blood from
beneath the centre of the macula. The procedure is technically simple, and the rate of serious complications appears to be low. Most patients
enjoy visual improvement coincident with blood displacement.
Sub macular hemorrhage, tissue plasminogen activator, SF6 gas