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Intravitreal injection of tissue plasminogen activator and gas bubble for treatment of subretinal hemorrhage in ARMD.

BACKGROUND
Subretinal hemorrhage (SRH) can arise from any number of underlying etiologies and can stem from either the choroidal and/or retinal circulation. It is most commonly associated with age-related macular degeneration (ARMD), in which a choroidal neovascular membrane is the usual source of bleeding. Vision loss resulting from SRH can be secondary to toxic, tractional, and barrier effects from persistent blood. To minimize long-term visual loss from SRH, several treatment modalities have evolved over the past few years. The most-recent therapeutic techniques involve treatment with the thrombolytic agent tissue plasminogen activator The value of surgical removal of subretinal hemorrhage to improve visual outcome remains unsubstantiated, as definitive studies have not been completed.


CASE REPORT
A 73-year-old man manifested a 1-day history of decreased vision in his right eye. A large submacular hemorrhage had developed as a result of exudative age-related macular degeneration. Treatment included intravitreal injection of tissue plasminogen activator, followed by intravitreal injection of SF6 gas, which displaced the subretinal hemorrhage away from the fovea and resulted in clearance of the submacular blood. This case describes a new treatment for submacular hemorrhage secondary to ARMD.


CONCLUSIONS
Subretinal hemorrhage secondary to ARMD can cause significant permanent visual loss. A thorough understanding of the pathogenesis of vision loss and the treatment options available are essential in successful management of these patients. Intravitreal injection of tissue plasminogen activator and gas bubble may provide an effective treatment for subretinal hemorrhage in age-related macular degeneration.