Kunjukunju Nancy, Gonzales Christine R, Rodden William S
Ochsner Medical Center, New Orleans, Louisiana;
Clin Ophthalmol. 2011;5:155-7. doi: 10.2147/OPTH.S16134. Epub 2011 Feb 4.
Suprachoroidal hemorrhages are a vision-threatening complication, and poor visual outcome is correlated with increasing hemorrhage complexity. The recommended time of surgical drainage is 10-14 days after the hemorrhage begins to liquefy. We describe a case in which recombinant tissue plasminogen activator (r-tPA), alteplase, is injected within the suprachoroidal space before surgery to assist in the drainage of an organized clot prior to liquefaction. This is a report of a technique in which r-tPA is used in the intrachoroidal space to target the organized clot of suprachoroidal hemorrhage prior to drainage.
A 62-year-old male presented 12 days after retinal detachment repair with sudden ocular pain and vision loss after a Valsalva maneuver. Vision was light perception only, and intraocular pressure was 43 mmHg. Diagnosed with hyphema and suprachoroidal hemorrhage, the patient underwent surgery the following day. An injection of r-tPA 100 μg was given intracamerally, and an additional dose of r-tPA 100 μg was injected into the suprachoroidal space prior to surgery. Liquified by r-tPA, the clot was expressed through the sclerotomies. Best corrected vision in the eye eight months after the drainage procedure was 20/40.
To the author's knowledge, this is the first reported case in which r-tPA was successfully injected in the suprachoroidal space to liquefy and drain a suprachoroidal hemorrhage prior to natural dissolution.
脉络膜上腔出血是一种威胁视力的并发症，视力预后不佳与出血复杂性增加相关。推荐的手术引流时间是出血开始液化后的10 - 14天。我们描述了一例在手术前将重组组织型纤溶酶原激活剂（r - tPA）阿替普酶注入脉络膜上腔，以协助在液化前引流机化血块的病例。这是一篇关于在脉络膜上腔使用r - tPA在引流前靶向脉络膜上腔出血机化血块的技术报告。
一名62岁男性在视网膜脱离修复术后12天，在进行瓦尔萨尔瓦动作后突然出现眼痛和视力丧失。视力仅为光感，眼压为43 mmHg。诊断为前房积血和脉络膜上腔出血，患者于次日接受手术。术中前房内注射100 μg r - tPA，并在手术前向脉络膜上腔额外注射一剂100 μg r - tPA。血块被r - tPA液化后，通过巩膜切口排出。引流手术后八个月，患眼的最佳矫正视力为20/40。
据作者所知，这是首例报告的在脉络膜上腔成功注射r - tPA以在自然溶解前液化和引流脉络膜上腔出血的病例。
