Early Evacuation of Massive Subretinal Hemorrhage with Low-dose Tissue Plasminogen Activator.

Choi, Mi Young; Kang, Se Woong

Original Article

Journal of the Korean Ophthalmological Society 1996;37(7):1139-1148.
Published online July 1, 1996.

Early Evacuation of Massive Subretinal Hemorrhage with Low-dose Tissue Plasminogen Activator.

Mi Young Choi, Se Woong Kang

Department of Ophthalmology, College of Medicine, Chungbuk National University, Cheongju, Korea.

과다한 망막하출혈에 대하여 저용량의 조직플라스미노겐 활성제를 이용한 조기의 수술적 제거

최미영(Mi Young Choi),강세웅(Se Woong Kang)

Abstract

Massive subretinal hemorrhage may develop secondary to choroidal neovascularization. The poor visual prognosis associated with submacular hemorrhage can be explained by preexisting abnormality of photoreceptorretinal pigment epithelium-Bruch's membrane complex and fibrin-mediated injury to the outer segment of photoreceptor. An animal experiment showed that subretinal fibrin induced irreversible damage to the retina within 24 hours. We use recombinant tissue plasminogen activator(rt-PA), at doses(3 microgram substantially lower than previously reported, to aid in the surgical evacuation of massive subretinal hemorrhage within 2 days of its development. The subretinal hemorrhage in both patients developed in association with age-related macular degeneration. Postoperative corrected visual acuity improved from counting fingers to 0.3 in one patient and from hand motion to 0.04 in the other. There has been no complication except ocular hypertension which is medically controllable. Subfoveal neovascularization explains poor postoperative vision in one case. It seems that visual recovery is facilitated by early evacuation of massive subretinal hemorrhage and by using low-dose rt-PA. Low-dose rt-PA may minimize the risks of intraocular hemorrhage and retinal toxicity.

Key Words: Early removal;Sub retinal hemorrhage;Tissue plasminogen activator