A NOVEL TECHNIQUE FOR SUBRETINAL HEMATOMA MIGRATION: Directing the Lesion Toward Artificial Retinal Detachment.

Abstract

To investigate a new method for controlling the direction of subretinal hematoma migration during tissue plasminogen activator (tPA) treatment by selecting the tPA injection site. Retrospective, interventional case series. An artificial retinal detachment was created by subretinal injection of tPA into the healthy lower retina of 18 patients, temporal to the fovea. The posterior pole of the detached retina was continuous with the subretinal hematoma, allowing tPA to access the lesion. After tPA infusion, the vitreous cavity was filled with SF 6 gas, and the surgery was concluded. Foveal subretinal hematoma size decreased from 610 ± 489 µ m preoperatively to 68 ± 134 µ m 1 month postoperatively. In all the cases, the subretinal hematoma moved downward from the temporal side of the fovea. Postoperatively, the mean difference in the angle between the tPA injection site (centered on the fovea centralis) and the hematoma's final position was 19° ± 14°, and the hematomas migrated toward the artificial retinal detachment site. It is feasible to manipulate the migration of subretinal hematoma toward an artificial retinal detachment created by subretinal tPA injection outside the lesion. This approach may minimize macular compromise in lesions superior to the macula.