Alexandra Dumitrescu Dragan_Mostafa Elgohary_SCIENTIFIC POSTER 2015


To evaluate visual acuity and anatomical outcome in patients with submacular hemorrhage due to neovascular age-related macular degeneration treated with tissue plasminogen activator (tPA) intravitreal injection and anti-VEGF medications followed 24-48 hours later by perfluoropropane (C3F8) or sulphur hexafluoride (SF6) gas injection or pars plana vitrectomy and submacular drainage.

Design & setting:

This is a retrospective case series from a secondary care retina unit, London, UK.


Twelve eyes of 12 patients who presented with loss of vision due to submacular hemorrhage of >= 2.5 disc areas were treated with intravitreal injection of tPA (25 to 100 microgram/0.1ml) combined with either Ranibizumab (Lucentis, 0.5mg/0.05ml), Aflibercept (Eylea, 2 mg/0.05) or Bevacizumab (Avastin, 1.25mg/0.05ml) and followed 24 hours later by either intravitreal injection of 0.4ml of 100% C3F8 (n=9) or submacular drainage of subretinal hemorrhage and sulphur hexafluoride (n=3). The outcome of interest was final best-corrected Snellen visual acuity.


Patient age ranged between 79.4 and 94.7 years and follow up between 6 weeks to 6 months. Seven patients (58.3%) experienced improvement in visual acuity; in 5 patients (41.6%) of 2 or more Snellen lines. Partial or complete displacement or absorption of the submacular hemorrhage occurred in association with visual improvement. Lack of visual improvement occurred in patient who presented with massive submacular hemorrhage (>3 disc areas horizontal diameter and >1000 microns central macular thickness) and who presented later than 6 weeks after the onset of hemorrhage.


Prompt treatment of patients with submacular hemorrhage with tPA combined with anti-VEGF and either pneumatic displacement or submacular drainage may lead to visual impromvement in a large proportion of patients with submacular hemorrhage due to neovascular AMD.

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