Subretinal versus intravitreal injection of recombinant tissue plasminogen activator in post-traumatic submacular hemorrhages

Considering the administration of rtPA, our experience agrees with the actual trends of treatment. The first case treated with subretinal rtPA shows quick blood reabsorption with good anatomical and functional outcome since 1 month after treatment. Three months later, the visual acuity (VA) was completely restored. The second case instead, treated with intravitreal rtPA, showed persistence of subretinal blood and low VA 1 month after treatment. Five months later, the central retina showed focal gaps in the photoreceptor layers, VA did not improved and patient complained for central scotomas. The blood lasting in the retina may have caused focal death of the photoreceptors, resulting in the gaps which can be seen on OCT B-scan 5 months after treatment. This poor outcome could also depend on the localization of the haemorrhage: indeed the blood was not only subretinal but also intraretinal, so the anatomical architecture in this patient was more affected than in the other one, interfering with a complete restauration. Maybe the rtPA administered subretinally would have allowed a fast recovery and a better outcome.