Subretinal injection of recombinant tissue of plasminogen activator and intravitreal injection in the management of subretinal hemorrhages secondary to age-related macular degeneration. A report of eight cases

Purpose Complicated forms of AMD are the final stage of a disease leading to deep and permanent visual loss.All current therapeutic advances are opening up real prospects but no consensus has been established despite the efficiency of the subretinal injection of fibrinolytic un macular hematoma.We aimed to assess subretinal injection of rt-PA associated with anti-VEGF in the hematoma as a complication of AMD and to establish predictors of efficacy in order to identify target patients. Methods Inclusion criteria were patients with subretinal hematoma as a complication of AMD active for less than 15 days and treated with the same surgical technique: vitrectomy, subretinal injection of rt-PA, intravitreal gas and anti-VEGF injections. Data from preoperative clinical exam at 3, 6 and 12 months postoperative were recorded. Results Eight patients with extensive hematoma were included. 62 % patients showed significant improvment at 6 months (p=0,04) contrary to the one year results.Displacement of hematoma was observed in all patients and no complication during the surgery is noted. The mean dose of rt-PA is 50 µg/ml. All patients received locoregional anesthesia. Postoperative complications were cataract (25%), recurrent hemorrhage (25%), and ocular hypertension (12%). No cases of endophtalmitis or retinal detachment is observed. Conclusion The extensive recent hemorrhage with underlying healthy macula appears to respond to treatment contrary to the old hematoma with pigment epithelium rupture and the hematoma after anti-VEGF injections responsible of large pigment epithelium detachment.