Vitrectomy without tissue plasminogen activator effective for submacular hemorrhage
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NEW YORK — Vitrectomy using balanced saline solution without tissue plasminogen activator is effective for displacement of thick submacular hemorrhage, according to a speaker here.
“As you all know, displacing a large submacular hemorrhage has a lot of different treatment options. Most of them utilize tissue plasminogen activators (tPA) to displace and analyze the clot,” Marwan Abdulaal, MD, said at the American Society of Retina Specialists annual meeting. “However, sometimes tPA can have limited availability, especially in a private practice setup.”
Abdulaal and colleagues examined outcomes in eyes that received subretinal displacement for submacular hemorrhage via balanced saline solution without tPA to determine the safety and efficacy of this method. Neovascular age-related macular degeneration was the most common etiology associated with thick submacular hemorrhage, and complete blood displacement occurred within 1 month in 79% of cases, according to the study.
At 12 months of follow-up, a significant improvement in average logMAR best corrected visual acuity occurred in affected eyes from 1.6 ± 0.6 (20/800) at baseline to 0.9 ± 0.42 (20/160; P = .001). No positive correlation was observed between final visual outcomes and risk factors for poor visual outcomes, and factors including oral anticoagulation before surgery and crystalline lens status did not affect outcome measures. Early postoperative complications were noted, including retinal detachment in one case and vitreous hemorrhage in two cases.
“Also, injecting air in the subretinal space is very effective to displace the blood away from the fovea as quickly as possible to save the central vision of the patient,” Abdulaal said.
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Abdulaal M, et al. Subretinal pneumatic displacement without tissues plasminogen activator for submacular hemorrhage: One-year outcomes. Presented at: American Society of Retina Specialists annual meeting; July 13-16, 2022; New York.
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