• Macular degeneration
• Macular haemorrhage
• Pars plana vitrectomy
• Pneumatic displacement
• Recombinant Plasminogen activator
• RtPA
• Submacular haemorrhage
• Subretinal haemorrhage
• Subretinal lavage

• Humans
• Retrospective Studies
• Vitrectomy/methods
• Male
• Retinal Hemorrhage/surgery
• Retinal Hemorrhage/therapy
• Retinal Hemorrhage/diagnosis
• Female
• Visual Acuity/physiology
• Aged
• Aged, 80 and over
• Tissue Plasminogen Activator/therapeutic use
• Tissue Plasminogen Activator/administration & dosage
• Middle Aged
• Fibrinolytic Agents/therapeutic use
• Follow-Up Studies
• Endotamponade/methods
• Tomography, Optical Coherence

• Universität Ulm (1055)

• retinal diseases
• macular degeneration

• Tissue Plasminogen Activator/administration & dosage
• Retina/diagnostic imaging
• Air/analysis
• Pressure
• Humans
• Injections, Intraocular
• Retinal Hemorrhage/diagnosis

• KU2024 Konkuk University

• Humans
• Retrospective Studies
• Visual Acuity/physiology
• Male
• Retinal Hemorrhage/diagnosis
• Retinal Hemorrhage/physiopathology
• Retinal Hemorrhage/surgery
• Retinal Hemorrhage/etiology
• Female
• Vitrectomy/methods
• Aged
• Tissue Plasminogen Activator/administration & dosage
• Tomography, Optical Coherence/methods
• Follow-Up Studies
• Endotamponade/methods
• Treatment Outcome
• Middle Aged
• Time Factors
• Aged, 80 and over
• Fibrinolytic Agents/therapeutic use
• Fibrinolytic Agents/administration & dosage

• primary vitreoretinal lymphoma
• 41-gauge silicone fine-needle retinal biopsy
• vitrectomy
• cytology
• case series

• Humans
• Retrospective Studies
• Retinal Neoplasms/surgery
• Retinal Neoplasms/diagnosis
• Retinal Neoplasms/pathology
• Male
• Female
• Biopsy, Fine-Needle/methods
• Vitreous Body/pathology
• Vitreous Body/surgery
• Aged
• Middle Aged
• Tomography, Optical Coherence/methods
• Retina/pathology
• Silicones
• Intraocular Lymphoma/diagnosis
• Intraocular Lymphoma/surgery
• Intraocular Lymphoma/pathology
• Vitrectomy/methods
• Lymphoma/diagnosis
• Lymphoma/surgery
• Lymphoma/pathology
• Aged, 80 and over
• Adult

• ophthalmology
• optimization
• subretinal injection
• surgical robotics
• system design and analysis

• R01 EB025883 NIBIB NIH HHS

• anti-VEGF agents
• lasers
• retinal vascular disease
• vitreoretinal surgery
• vitreous hemorrhage

• Blood-retinal barrier
• Ocular drug delivery
• Prodrug
• Retina
• Sustained release formulations

• Angiogenesis inhibitors
• Choroidal neovascularization
• Heparin
• Vascular endothelial growth factor

• medical retina
• ophthalmology
• vetreoretinal

• Humans
• Macular Degeneration/complications
• Macular Degeneration/drug therapy
• Randomized Controlled Trials as Topic
• Retinal Hemorrhage/drug therapy
• Retinal Hemorrhage/surgery
• Tissue Plasminogen Activator
• Visual Acuity
• Vitrectomy/methods

• Foundation Fighting Blindness

• Fibrinolytic Agents/therapeutic use
• Humans
• Intravitreal Injections
• Retinal Hemorrhage/diagnosis
• Retinal Hemorrhage/drug therapy
• Retinal Hemorrhage/surgery
• Retrospective Studies
• Tissue Plasminogen Activator/therapeutic use
• Tomography, Optical Coherence
• Visual Acuity
• Vitrectomy

This report describes a series of cases with massive subretinal hemorrhage (SRH) due to age-related macular degeneration (AMD) treated by subretinal alteplase injections. In all cases, the surgical technique consisted in 25-gauge pars plana vitrectomy (PPV) and alteplase injection under the retina using a 38-gauge cannula. After the fluid-gas exchange, bevacizumab injection was performed in all patients. Three cases of SRH in which this technique was used, as well as their evolution at one week and one month postoperatively are described. Visual acuity was hand motion in all three cases at presentation. After surgery, a significant anatomical and functional improvement was noted in all cases. One month postoperatively, none of the patients had blood under the macula, and visual acuities significantly improved to 0.8, 0.2 and 0.16 (decimal fraction). A consistent reduction of central retinal thickness was observed on optical coherence tomography (OCT) from the first week postoperatively. No intra and postoperative complications were noted. Subretinal alteplase injection proved as a viable solution in these severe SRH with early presentation. There was no need to change the systemic anticoagulant and antiaggregant therapy. Bevacizumab intravitreal injection at the end of surgery has an important role in preventing further bleeding.

• age-related macular degeneration
• alteplase
• subretinal hemorrhage
• subretinal injection

• Subretinal hemorrhage
• silicone oil
• tissue plasminogen activator
• ultra-wide field imaging
• vitrectomy

Fovea-involving subretinal haemorrhage is challenging to manage with uncertain visual outcomes. We reviewed outcomes of patients with fovea-involving macular haemorrhage treated with pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) with pneumatic displacement.

This is a retrospective interventional case series. All patients with submacular haemorrhage who underwent PPV with subretinal tPA injection were included. Reasons for exclusion encompassed patients who underwent intravitreal tPA injection in the office without surgery, insufficient follow-up or documentation. Primary outcomes of interest were postoperative visual acuity (VA) at month 1 and 3. Secondary outcomes were median VA at month 3 by location of haemorrhage and underlying diagnosis.

Thirty-seven total patients were included. The mean age was 68.2 years, with 54.1% (20/37) females. The most common aetiology was exudative macular degeneration (43.2%), followed by undifferentiated choroidal neovascularisation (CNV) (18.9%), polypoidal choroidal vasculopathy (18.9%), traumatic CNV (10.8%), macroaneurysm (5.4%) and proliferative diabetic retinopathy (2.7%). Median preoperative VA was 20/2000, postoperative month 1 was 20/347 (p<0.01), improving to 20/152 (p<0.01) at month 3. Proportion of patients gaining vision 3+ lines in vision was 15/36 (42%). Mean preoperative central subfield thickness on optical coherence tomography was 512.2 µm for sub-retinal pigment epithelium haemorrhage and 648.2 µm for subretinal haemorrhage (p=0.48). Difference in VA by diagnosis was not significant (p=0.60).

PPV with subretinal tPA injection and pneumatic displacement of submacular haemorrhage offers modest visual recovery for a diverse group of patients. Location of haemorrhage or specific diagnosis may not predict outcome.

• macula
• neovascularisation
• retina
• treatment surgery

The sub-retinal injections are not very commonly performed procedures in vitreoretina, but form a crucial step in any cell replacement therapy for retinal diseases. The purpose of this study is to describe the learning curve of a trained vitreo-retinal surgeon in sub-retinal injections in a rat model and its implications in future clinical trials.

This is an in-vivo retrospective animal study using Wistar rats. All ARVO guidelines regarding animal handling were followed. After anesthetization, aspectic preparation and dilating the pupils with 1% tropicamide eye drops, subretinal injection of 10 μl saline was done via a limbal entry. Data recorded included time taken for the procedure, success of injection, associated complications, post-operative infections and complications. The rats were followed up for 1 month post procedure. A trend analysis was done for the above factors to look for improvement in ease of procedure, reduction in procedure time and reduction in complications for the clinician using a novel objective scale.

About 20 eyes were studied. Mean weight of the rats was 188 ± 12.82 gram. Mean time taken for the procedure was 14.1 ± 5.07 minutes. There was a significant inverse co-relation between the serial number of the eye and time taken for the procedure (r = −0.89, P < 0.0001). Comparative complications noted between the first ten and the last ten eyes were: conjunctival tear 30% versus 10% (P = 0.27), lens touch 50% versus 10% (P = 0.05), subretinal hemorrhage 40% versus 0% (P = 0.13), vitreous loss 30% versus 0% (P = 0.06). The successful subretinal injection without intraocular complications was achieved in 40% versus 90% (P = 0.02). There was a significant co-relation between the serial number of the eye and ease of the procedure (r = 0.87, P < 0.0001). Post operatively none of the eyes had any infection. Six eyes (12%) developed cataract and 3 eyes (6%) had non-resolving retinal detachment at the last examination visit.

Subretinal injections in rats have a definite learning curve even for a trained vitreoretinal surgeon. This should be accounted for and resources allocated accordingly to achieve good technical comfort and negate confounding by the surgeon factor in the results of future clinical trials

• Rat model
• retinal stem cells
• subretinal injections

Suprachoroidal hemorrhage (SCH) is a rare but potentially catastrophic ocular event. Surgery for SCH is often challenging because of the difficulty in resolving the retinal and choroidal detachment. Here, we describe a novel surgical technique in which urokinase is administered by sub-Tenon’s injection to target an organized clot in SCH prior to drainage.

A consecutive case series of four eyes with serous and hemorrhagic choroidal detachments secondary to cataract surgery or trauma was documented to evaluate the feasibility of using a sub-Tenon’s urokinase injection-assisted 23-gauge and 20-gauge incision to drain choroidal detachments. Urokinase (2000 IU) was given by sub-Tenon’s injection one day before surgery for clot liquefaction. A 23-gauge infusion line was placed in the anterior chamber. A 20-gauge incision was created in the suprachoroidal space 3.5 mm from the limbus. After drainage, pars plana vitrectomy was performed because of concomitant pathology that demanded this additional procedure. Visual acuity, ocular findings, the timing of surgical interventions, surgical procedures, and outcomes were retrospectively reviewed in four patients. Postoperative follow-up of the patients ranged from 6 to 24 mo (mean, 13 mo). After the treatment, all patients achieved excellent anatomical recovery.

Sub-Tenon’s urokinase injection-assisted vitrectomy makes clot liquefaction happen in the early treatment stage, resulting in marked stability during the procedure.

• Urokinase
• Suprachoroidal hemorrhage
• Choroidal detachments
• Vitrectomy
• Case report