Silvia Bopp, Klaus Lucke (Augenklinik Universitaetsallee, Bremen, Germany)


To protect the fovea from severe toxic damage due to submacular hemorrhage and avoiding subretinal surgical manipulations.


Indications for surgery are fresh subfoveal hemorrhages due to exudative macular degeneration (ARMD) or ruptured retinal arterial macroaneurysms (RAM). After vitrectomy, r-TPA (25µg/0,1cc) is injected subretinally via a 40G cannula, followed by a subtotal gas filling. The patient remains supine for 2 hours postoperatively to allow blood lysis and afterwards keeps face-down positioning for 48 hours to enable blood displacement to the periphery.

Effectiveness / Safety:

Functional prognosis after submacular hemorrhage is poor. Conventional removal of subfoveal hemorrhage carries the risk of iatrogenic damage to the retina and RPE. The technique presented is effective to remove hemorrhages out of the fovea area. Complications due to the subretinal injection technique were not observed. Further therapy depends on the underlying disease. In case of ARMD, subsequent anti-VEGF therapy is necessary to keep the SCNV under control. If ruptur of a RAM was causative for subretinal hemorrhage, additional laser treatment may be indicated to facilitate RAM closure.

Take-Home Message:

Vitrectomy and subretinal r-tPA injection with postoperative positioning is a minimal-invasive, safe and effective method to displace subfoveal hemorrhage and allow a timely subsequent therapy depending on the underlying disease.