Currently, the use of intravitreally injected tissue plasminogen activator
(tPA) and expansile gas is an effective treatment to rapidly displace subretinal
hemorrhage. I read with interest the recent article by Handwerger et al,1 who presented a retrospective series of 14 patients.
However, I believe that some points in this study should be clarified.
First, I am surprised that the supplier of tPA was not mentioned in
the article. Detailed information about the dilution volume and buffer used
would be of great value because both can severely influence the enzymatic
activity of tPA. The reader would also like to know what type of syringe was
used that allows a differentiation between 18, 20, 24, and 30 µg of
injected tPA? What was the rationale for injecting 5 different doses of tPA
in a series of 14 patients?
Hesse L. Treating Subretinal Hemorrhage With Tissue Plasminogen Activator. Arch Ophthalmol. 2002;120(1):102-103. doi: