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Titre	Submacular tPA injection to treat subretinal hemorrhages in age related macular degeneration (AMD)
Abstract Nr.	254

But	Although progress was made in the treatment of AMD with the advent of anti-VEGF treatment, several patients with wet AMD still develop a submacular hemorrhage. The extent of such hemorrhage often prohibits continued treatment with anti-VEGF injections. Displacement of the subretinal blood can be attempted by injecting a bubble of gas with or without tPA in the vitreous cavity and face-down positioning of the patient. However, since the subretinal penetration of tPA is limited, and positioning of elderly patients is difficult, the result of such treatment is limited.
Méthodes	During a 23G sutureless vitrectomy, tPA is injected in the subretinal space using a 41G needle. The injected volume of tPA induces a local retinal detachment over the macular area. At the end of surgery, the vitreous cavity is filled with air. The patient can keep a prone positioning after surgery. The air bubble floating in the upper part of the vitreous cavity pushes the liquefied blood downwards into the lower part of the created detachment. After resorption of the air and the subretinal fluid, the fovea is mostly blood-free with the subretinal membrane exposed for further treatment with anti-VEGF injections.
Résultats	Presently, 20 patients were treated with subretinal tPA injection. Analysis of the anatomical and visual acuity results will be presented.
Conclusion	Subretinal injection of tPA seems an effective way to treat patients with unilateral submacular hemorrhage and preserved vision in the fellow eye, when macular translocation is not indicated. Moreover, the surgical morbidity of this technique is minimal since the surgery is performed using the 23G sutureless technique, mostly under local anesthesia and no postoperative positioning is necessary.

Auteur 1

Nom	VANINBROUKX
Initiales	I
Institut	UZLeuven
Ville	Leuven

Auteur 2

Nom	Van Calster
Initiales	J
Institut	UZLeuven
Ville	Leuven

Auteur 3

Nom	Stalmans
Initiales	P
Institut	UZLeuven
Ville	Leuven