SF6 with tPA not recommended for ruptured retinal arterial macroaneurysms

This retrospective review assessed the safety and complications of intravitreal injection of sulfur hexafluoride (SF6) gas with or without tissue plasminogen activator (tPA) for displacing submacular hemorrhage.  

The review included 39 eyes in which the submacular hemorrhage was related to exudative age-related macular degeneration (AMD) and 14 eyes with ruptured retinal arterial macroaneurysms.

At a mean follow up of 18.4 months, visual acuity improved by three or more lines in 64.2 percent. Vision stabilized within three lines in 28.3 percent, and deteriorated in 7.5 percent.

In eyes with AMD, hemorrhage, including vitreous hemorrhage, recurred in 22.2 percent of 36 tPA-treated eyes and in 33.3 percent of three eyes not treated with tPA. However in eyes with macroaneurysms, the recurrence rate was much greater in the tPA-treated patients (100 percent vs. 10 percent). Eight eyes underwent vitrectomy for recurrent hemorrhage.

During follow-up, photodynamic therapy or intravitreal ranibizumab or pegaptanib was administered in 41 percent of 39 eyes with AMD. They did not observe p ostoperative ocular hypertension persisting more than three days.

Although the series is retrospective and the macroaneurysm cohort is small, the findings would favor avoiding tPA in pneumatic displacement procedures for submacular hemorrhage in the setting of macroaneurysm. Pneumatic displacement of submacular hemorrhage without tPA may provide good visual outcomes with less re-bleeding.