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Title

Subretinal tissue plasminogen activator injection to treat submacular hemorrhages in age-related macular degeneration.

Purpose	To determine the efficacy and safety of 23G transconjunctival sutureless vitrectomy (TSV), subretinal tissue plasminogen activator injection (tPA) and pneumatic displacement with air/SF6 gas to treat submacular hemorrhages secondary to AMD.
Methods	Retrospective analysis of 74 patients (mean age 79.3 years), surgically treated for submacular hemorrhage caused by neovascular AMD between November 2008 and July 2012 at the University Hospitals Leuven. Main outcome measures: Short-term, best and final postoperative visual acuity, displacement of subretinal hemorrhage, and surgical complications.
Results	The submacular hemorrhage was successfully displaced in 86% of the patients. After the surgery, the visual acuity improved by 0.34 logMAR unit after two months and by 0.06 logMAR unit at the final visit (mean follow up 241 days). The best postoperative visual acuity increased by 0.46 logMAR unit. Complications consisted of 9 cases of recurrent hemorrhage, 2 vitreous hemorrhages, 7 cases of retinal detachment, and 2 subchoroidal hemorrhages during the follow-up period.
Conclusion	This study indicates that a surgical approach with 23G TSV, tPA and pneumatic displacement may be an effective procedure for submacular hemorrhage displacement in patients with AMD. The procedure induced an improved visual recovery. However, visual outcome is limited by the underlying macular pathology. Larger multicenter randomized controlled studies are warranted to determine the therapeutic effect of this surgical approach.

Authors 1

Last name	DEWILDE
Initials	E
Department	Afdeling Oogheelkunde UZLeuven
City	Leuven

Authors 2

Last name	DELAERE
Initials	L
Department	Afdeling Oogheelkunde UZLeuven
City	Leuven

Authors 3

Last name	VANINBROUKX
Initials	I
Department	Afdeling Oogheelkunde UZLeuven
City	Leuven

Authors 4

Last name	VAN CALSTER
Initials	J
Department	Afdeling Oogheelkunde UZLeuven
City	Leuven

Authors 5

Last name	STALMANS
Initials	P
Department	Afdeling Oogheelkunde UZLeuven
City	Leuven