To present a video of a massive submacular haemorrhage successfully treated with subretinal tissue plasminogen activator and pneumatic displacement.
Video case presentation.
An 80-year-old pseudophakic Caucasian lady was being successfully treated for neovascular age-related macular degeneration in her left eye with a visual acuity of 6/9 after two monthly injections of intravitreal ranibizumab. One week before her third injection she presented with acute painless central vision loss in that eye. Visual acuity was reduced to hand motions and a large submacular hemorrhage extending to the vascular arcades was detected. The location of the blood was confirmed to be subretinal by optical coherence tomography and fundus autofluorescence. Urgent 25-gauge three-port pars plana vitrectomy was performed with subretinal injection of the recombinant tissue plasminogen activator tenecteplase (Metalyse Æ). A partial fluid-air-gas (20% sulfur hexafluoride) exchange was performed. Post-operatively the patient was postured at 45 degrees face down for three days. Two weeks post-operatively almost all the subretinal haemorrhage had been displaced to the far inferior retina and the visual acuity had improved back to 6/24.
Subretinal injection of tissue plasminogen activator combined with pneumatic displacement can be used to successfully treat massive submacular haemorrhages.