ABSTRACT
Recombinant tissue plasminogen activator (rtPA) has been used systemically in the management of acute myocardial infarction since 1984. Side-effects and complications of intracameral rtPA include hyphema, corneal stromal thickening, elevated intraocular pressure, breakthrough vitreous hemorrhage, endophthalmitis, retinal break with detachment, sub-retinal rebleed, and exudative retinal detachment with pigmentary retinopathy following spontaneous resolution. This chapter shows the progression of the surgical management of submacular hemorrhage, beginning with the least invasive procedure and ending with the most invasive. A retinotomy is created at the edge of the hemorrhage away from the foveola to allow manipulation of instrumentation in the subretinal space without creating undue traction on the retinotomy site. Multiple retinotomy sites may facilitate expression of the subretinal hemorrhage. A double-barreled needle may be inserted through the retinotomy site into the subretinal space to encourage breakup of the clot and aspiration from within the subretinal space. Subretinal irrigation with rtPA induces subretinal clot lysis and facilitates clot removal.
