Treating Submacular Hemorrhage with Intravitreal tPA Injection and Pneumatic Displacement

Background: This report describes the clinical outcome in an adult male with spontaneous submacular hemorrhage who underwent successful intravitreal tPA injection and pneumatic displacement.

Case Presentation: A 30 yr old male patient presented with complaints of sudden painless diminution of vision in left eye since one day. The vision on presentation was Hand Movements +. Fundus showed a submacular hemorrhage with breakthrough vitreous hemorrhage. Injection tPA (25μg in 0.05 ml) and pure sulfur hexafluoride (SF6, 0.3 ml) was injected into the vitreous cavity. After surgery the patient was instructed to maintain a prone position. This was followed by a vitrectomy after 2 weeks. Postoperatively, patient had significantly improved having an unaided vision of 6/9P in the left eye which improved to 6/6 on correction.

Conclusion: Intravitreal tPA and pneumatic displacement using pure SF6 is an effective treatment for submacular hemorrhage.