Evangelia Papavasileiou, S. Liazos, Timothy Jackson (London, UK)


To describe the safety and efficacy of intravitreal TPA and C3F8 for the management of extensive sub macular hemorrhages (SMH), associated with AMD related choroidal neovascularisation (CNV) or Idiopathic Polypoidal Choroidal Vasculopathy (IPCV).


Consecutive case series of 7 patients, presenting with acute SMH from neovascular AMD (N = 5) and IPCV (N = 2).  Duration of visual loss was less than 1 week Treatment involved intravitreal injection of TPA (50 micrograms in 0.05 ml) and C3F8 100% (O.3 ml) and prone posturing for 1 week. Displacement of SMH was assessed by digital color photography and diagnosis of CNV/IPCV was reclassified using FFA/ICG. In the cases of AMD-related CNV (N = 5), monthly intravitreal injections of Ranibizumab (Lucentis) were offered, whereas in the cases of IPCV (N = 2) Argon laser photocoagulation of the polyps was applied within 2 weeks postoperatively.

Effectiveness / Safety:

Adequate displacement of SMH within 1 week was achieved in 6/7 patients. Improvement of VA was observed in 6/7 patients and 4/7 gained > 2 Snellen lines at 9 weeks postoperatively.

Complications: 1 patient had increased IOP 1 day post op.

Take home message:

Intravitreal TPA and gas C3F8 assisted pneumatic displacement of SMH is a safe and effective intervention in cases of extensive SMH. It can improve VA and assist the diagnosis and treatment plan of the underlying cause.