Surgical treatment policy using recombinant prourokinase for submacular hemorrhages

: An immunofluorescence technique was used to study the transretinal penetration of intravitreal fibrinolytic agent Hemase (a recombinant urokinase) in an experiment on 4 rabbit eyes. Hemase (54 kD) was proved to be able to penetrate across all retinal layers 2 hours after intravitreal administration. The efficacy of Hemase was tested in the treatment of submacular hemorrhages (SMH) of various etiology. Thirteen patients with SMH associated with age-related macular degeneration or ophthalmic injury were enrolled in the study. Hemase 500 IU was intravitreally injected 24 hours before pneumatic dislocation of SMH in 10 patients. In 3 patients with massive SMH, the proposed vitrectomy procedure was employed, by epiretinally injecting the fibrinolytic agent under a gas bubble, followed by drainage of the subretinal space. The operation was ended, by administering air and Hemase, and then by putting the patient in the supine position for 3-4 hours, thereafter his/her position was recommended to be changed to the prone position to realize the mechanism of pneumatic dislocation. The studies suggest that pneumatic SMH dislocation in combination with Hemase administration permits visual acuity to be increased in 80% of cases. The efficiency of manipulation and the functional outcome of treatment depend on the etiology of hemorrhage. The proposed vitrectomy technique using Hemase reduces neuroepithelial injury, effectively drains SMH, and dislocates its remnants from the foveal area.