Massive Subretinal Hemorrhages Treated with Subretinal Alteplase Injection: A Series of Clinical Cases Over a Decade
DOI:
https://doi.org/10.48560/rspo.33128Keywords:
Fibrinolytic Agents, Retinal Hemorrhage, VitrectomyAbstract
INTRODUCTION: Massive macular subretinal hemorrhages are accumulations of a large amount of blood between the neurosensory retina and the retinal pigment epithelium, occupying the macular area. The purpose of this study is to describe a series of patients who underwent surgical treatment for this complication and to report their functional outcomes.
METHODS: A case-series report of consecutive eyes, including 6 eyes diagnosed with large macular subretinal hemorrhages, which underwent pars plana vitrectomy with subretinal injection of alteplase, followed by SF6 tamponade. All surgeries were performed in Hospital Pedro Hispano – ULSM, by the same surgeon.
RESULTS: Cases 1 and 4 report macular subretinal hemorrhages in patients with previously diagnosed neovascular age-related macular degeneration. Cases 2 and 3 consist of hemorrhages in the context of retinal macroaneurysms. Case 5 depicts a large post-traumatic macular hemorrhage.
CONCLUSION: Neovascular age-related macular degeneration is the most common cause of catastrophic subretinal macular hemorrhages, but this complication may be associated with a broader spectrum of retinal diseases. Untreated cases have a very poor visual prognosis, and one of the existing therapeutic options consists of pars plana vitrectomy with subretinal injection of a fibrinolytic agent, followed by an expansible gas tamponade. The final visual outcome may depend on several factors, including the timing of surgery, the patient's age, prior retinal diseases, and original visual acuity. In selected cases, a quick and appropriate intervention may exponentially improve the final visual outcomes.
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