Ophthalmic Surgery and Lasers
Volume 30 (3) * March 1999 * Clinical Science (abstrac
Preoperative Use of Tissue Plasminogen Activator for Large
Submacular Hemorrhage
Nauman A.
Chaudhry, MD; William F. Mieler, MD; Dennis P. Han, MD; Virgil D.
Alfaro III, MD; Peter E. Liggett, MD
BACKGROUND AND OBJECTIVE
Tissue Plasminogen
Activator (TPA) has been used as an adjunct in the surgical removal of
submacular hemorrhage. It is usually used intraoperatively, but may not
provide enough time for effective fibrinolysis, especially for a large
hemorrhage. The present study was conducted to evaluate the efficiency
and safety of preoperative use of TPA for large submacular hemorrhages.
METHODS
Five eyes with large
submacular hemorrhage secondary to age-related macular degeneration
underwent subretinal injection of TPA in the office 24 hours before
surgery. All hemorrhages were less than seven days old and at least 3 mm
thick.
RESULTS
Preoperative visual acuity
ranged from counting fingers to hand motion (HM). Patient follow-up
ranged from 3 months to 24 months (mean, 11 months). Final visual acuity
ranged from 20/30 to HM. Four of the five eyes (80%) showed improved
visual acuity after surgery and 3/5 (60%) attained visual acuity of
20/200 or better.
CONCLUSION
Preoperative use of TPA
for drainage of large submacular hemorrhage appears to be safe and may
result in efficient clot removal. The true efficacy of TPA in the
treatment of submacular hemorrhage can only be proven by a prospective
randomized trial.
[Ophthalmic Surg and Lasers 1999;30:176-180.]
AUTHORS
From the Department of Ophthalmology, Yale
University School of Medicine, New Haven, CT (Dr. Chaudhry), the Eye
Institute, Medical College of Wisconsin, Milwaukee, WI (Drs Mieler and
Han), Storm Eye Institute, University of South Carolina, Charleston, SC
(Dr. Alfaro). Dr. Liggett is currently in private practice in Hamden,
CT. Dr. Chaudhry is currently affiliated with the Bascom Palmer Eye
Institute, University of Miami School of Medicine, Miami, FL.
Accepted for publication December 9, 1998.
Presented in part at the annual meeting of the
Association for Research in Vision and Ophthalmology, Ft. Lauderdale,
FL, May, 1997. Address reprint requests to Peter E. Liggett, MD, 2440
Whitney Avenue, Hamden, CT. 06518
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