Prompt treatment in massive submacular hemorrhage is crucial because the condition threatens vision by causing macular scarring and retinal damage. Trans pars plana vitrectomy may be necessary for extensive and thick submacular hemorrhage. However, it is invasive and poses treatment burden on both patients and physicians. This video details the injection of submacular tissue plasminogen activator (tPA) and air using a 41-gauge needle without vitrectomy in patients with massive submacular hemorrhage. Only 1 vitrectomy port is required for the intraocular illumination probe, and a 41-gauge needle within the 28-gauge needle is inserted directly into the vitreous cavity through the conjunctiva. Submacular tPA (25 μg/0.1 cc) is injected with fine control of the infusion rate, with approximately 10-15 mm Hg of pressure applied. Then, filtered air is injected with a pressure of 10 mm Hg to the localized area of previously detached retina. This procedure is minimally invasive and effective in clearing massive subretinal hemorrhage with minimal postoperative complications.

Financial Disclosures: Drs. Min Kim, Seung Min Lee, Minha Kim, and Jae Won Jun disclose no financial relationships.