Successful displacement of a traumatic submacular hemorrhage in a 13-year-old boy treated by vitrectomy, subretinal injection of tissue plasminogen activator and intravitreal air tamponade: a case report

Shinichiro Doi, Shuhei Kimura, Yuki Morizane, Yusuke Shiode, Mio Hosokawa, Masayuki Hirano, Mika Hosogi, Atsushi Fujiwara, Kazuhisa Miyamoto, Fumio Shiraga

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3 Citations (Scopus)

Abstract

Abstract Background: The natural course of submacular hemorrhage resulting from traumatic choroidal rupture generally has a poor outcome unless treated. The intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) has been reported to be effective, but has also been reported to induce severe complications such as retinal detachment and vitreous hemorrhage. Recently, we reported a safe and effective procedure for treating submacular hemorrhage due to polypoidal choroidal vasculopathy (PCV) with a low dose of rt-PA. Here we report the application of this procedure to a case of traumatic submacular hemorrhage in a 13-year-old boy, which achieved a good visual outcome. Case presentation: A 13-year-old Japanese boy presented with a thick submacular hemorrhage in his left eye as a result of blunt trauma from being hit by a sinker. Best-corrected visual acuity (BCVA) was assessed as only able to perceive hand motions. We carried out a vitrectomy, subretinal injection of 4,000 IU rt-PA (6.9 μg) and air tamponade. The day after surgery, most of the submacular hemorrhage had moved to the inferior periphery. One month after the surgery, we observed cataract formation, thin remnants of the submacular hemorrhage and juxtafoveal choroidal rupture. We carried out cataract surgery and injected bevacizumab intravitreally to prevent the development of choroidal neovascularization. Two months after the second surgery, the submacular hemorrhage had totally disappeared and the patient had a BCVA of 20/40. Conclusion: Vitrectomy, subretinal injection of rt-PA, and intravitreal air tamponade may be a promising strategy for treating traumatic submacular hemorrhage in young patients.

Original languageEnglish
Article number90
JournalBMC Ophthalmology
Volume15
Issue number1
DOIs
Publication statusPublished - Aug 7 2015

Fingerprint

Vitrectomy
Tissue Plasminogen Activator
Air
Hemorrhage
Injections
Cataract
Visual Acuity
Rupture
Choroid Hemorrhage
Gases
Retinal Hemorrhage
Vitreous Hemorrhage
Choroidal Neovascularization
Intravitreal Injections
Retinal Detachment
Ambulatory Surgical Procedures
Hand
Wounds and Injuries

Keywords

  • Air tamponade
  • Choroidal rupture
  • Recombinant tissue plasminogen activator
  • Subretinal injection
  • Traumatic submacular hemorrhage
  • Vitrectomy

ASJC Scopus subject areas

  • Ophthalmology

Cite this

@article{db6135b6a86647e5b20a26cb6d30080d,
title = "Successful displacement of a traumatic submacular hemorrhage in a 13-year-old boy treated by vitrectomy, subretinal injection of tissue plasminogen activator and intravitreal air tamponade: a case report",
abstract = "Abstract Background: The natural course of submacular hemorrhage resulting from traumatic choroidal rupture generally has a poor outcome unless treated. The intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) has been reported to be effective, but has also been reported to induce severe complications such as retinal detachment and vitreous hemorrhage. Recently, we reported a safe and effective procedure for treating submacular hemorrhage due to polypoidal choroidal vasculopathy (PCV) with a low dose of rt-PA. Here we report the application of this procedure to a case of traumatic submacular hemorrhage in a 13-year-old boy, which achieved a good visual outcome. Case presentation: A 13-year-old Japanese boy presented with a thick submacular hemorrhage in his left eye as a result of blunt trauma from being hit by a sinker. Best-corrected visual acuity (BCVA) was assessed as only able to perceive hand motions. We carried out a vitrectomy, subretinal injection of 4,000 IU rt-PA (6.9 μg) and air tamponade. The day after surgery, most of the submacular hemorrhage had moved to the inferior periphery. One month after the surgery, we observed cataract formation, thin remnants of the submacular hemorrhage and juxtafoveal choroidal rupture. We carried out cataract surgery and injected bevacizumab intravitreally to prevent the development of choroidal neovascularization. Two months after the second surgery, the submacular hemorrhage had totally disappeared and the patient had a BCVA of 20/40. Conclusion: Vitrectomy, subretinal injection of rt-PA, and intravitreal air tamponade may be a promising strategy for treating traumatic submacular hemorrhage in young patients.",
keywords = "Air tamponade, Choroidal rupture, Recombinant tissue plasminogen activator, Subretinal injection, Traumatic submacular hemorrhage, Vitrectomy",
author = "Shinichiro Doi and Shuhei Kimura and Yuki Morizane and Yusuke Shiode and Mio Hosokawa and Masayuki Hirano and Mika Hosogi and Atsushi Fujiwara and Kazuhisa Miyamoto and Fumio Shiraga",
year = "2015",
month = "8",
day = "7",
doi = "10.1186/s12886-015-0090-3",
language = "English",
volume = "15",
journal = "BMC Ophthalmology",
issn = "1471-2415",
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TY - JOUR

T1 - Successful displacement of a traumatic submacular hemorrhage in a 13-year-old boy treated by vitrectomy, subretinal injection of tissue plasminogen activator and intravitreal air tamponade

T2 - a case report

AU - Doi, Shinichiro

AU - Kimura, Shuhei

AU - Morizane, Yuki

AU - Shiode, Yusuke

AU - Hosokawa, Mio

AU - Hirano, Masayuki

AU - Hosogi, Mika

AU - Fujiwara, Atsushi

AU - Miyamoto, Kazuhisa

AU - Shiraga, Fumio

PY - 2015/8/7

Y1 - 2015/8/7

N2 - Abstract Background: The natural course of submacular hemorrhage resulting from traumatic choroidal rupture generally has a poor outcome unless treated. The intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) has been reported to be effective, but has also been reported to induce severe complications such as retinal detachment and vitreous hemorrhage. Recently, we reported a safe and effective procedure for treating submacular hemorrhage due to polypoidal choroidal vasculopathy (PCV) with a low dose of rt-PA. Here we report the application of this procedure to a case of traumatic submacular hemorrhage in a 13-year-old boy, which achieved a good visual outcome. Case presentation: A 13-year-old Japanese boy presented with a thick submacular hemorrhage in his left eye as a result of blunt trauma from being hit by a sinker. Best-corrected visual acuity (BCVA) was assessed as only able to perceive hand motions. We carried out a vitrectomy, subretinal injection of 4,000 IU rt-PA (6.9 μg) and air tamponade. The day after surgery, most of the submacular hemorrhage had moved to the inferior periphery. One month after the surgery, we observed cataract formation, thin remnants of the submacular hemorrhage and juxtafoveal choroidal rupture. We carried out cataract surgery and injected bevacizumab intravitreally to prevent the development of choroidal neovascularization. Two months after the second surgery, the submacular hemorrhage had totally disappeared and the patient had a BCVA of 20/40. Conclusion: Vitrectomy, subretinal injection of rt-PA, and intravitreal air tamponade may be a promising strategy for treating traumatic submacular hemorrhage in young patients.

AB - Abstract Background: The natural course of submacular hemorrhage resulting from traumatic choroidal rupture generally has a poor outcome unless treated. The intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) has been reported to be effective, but has also been reported to induce severe complications such as retinal detachment and vitreous hemorrhage. Recently, we reported a safe and effective procedure for treating submacular hemorrhage due to polypoidal choroidal vasculopathy (PCV) with a low dose of rt-PA. Here we report the application of this procedure to a case of traumatic submacular hemorrhage in a 13-year-old boy, which achieved a good visual outcome. Case presentation: A 13-year-old Japanese boy presented with a thick submacular hemorrhage in his left eye as a result of blunt trauma from being hit by a sinker. Best-corrected visual acuity (BCVA) was assessed as only able to perceive hand motions. We carried out a vitrectomy, subretinal injection of 4,000 IU rt-PA (6.9 μg) and air tamponade. The day after surgery, most of the submacular hemorrhage had moved to the inferior periphery. One month after the surgery, we observed cataract formation, thin remnants of the submacular hemorrhage and juxtafoveal choroidal rupture. We carried out cataract surgery and injected bevacizumab intravitreally to prevent the development of choroidal neovascularization. Two months after the second surgery, the submacular hemorrhage had totally disappeared and the patient had a BCVA of 20/40. Conclusion: Vitrectomy, subretinal injection of rt-PA, and intravitreal air tamponade may be a promising strategy for treating traumatic submacular hemorrhage in young patients.

KW - Air tamponade

KW - Choroidal rupture

KW - Recombinant tissue plasminogen activator

KW - Subretinal injection

KW - Traumatic submacular hemorrhage

KW - Vitrectomy

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U2 - 10.1186/s12886-015-0090-3

DO - 10.1186/s12886-015-0090-3

M3 - Article

C2 - 26250101

AN - SCOPUS:84938819693

VL - 15

JO - BMC Ophthalmology

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SN - 1471-2415

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M1 - 90

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