Supplementary Material for: A case of traumatic submacular hemorrhage treated with tPA and pneumatic displacement

This is a case of a 31-year-old female who presented to the Emergency Department at a London teaching hospital with a 24-hour history of visual loss following an assault. The ophthalmological routine examination showed a sub-macular hemorrhage (SMH), and a computerized tomography (CT) scan demonstrated a displaced orbital floor fracture with inferior rectus entrapment and a medial wall fracture. To induce displacement of the SMH, intravitreal injection of 0.25 µg tissue plasminogen activator (tPA) was combined with 0.3 ml of intravitreal 100% perfluoropropane (C3F8) gas. At the 1-day follow-up, there was an inferotemporal displacement of the blood clot, and visual acuity improved from hand motions to 6/5 within 3 months. No complications occurred over 2 years of follow-up, with a final visual acuity of 6/5. This case shows us that intravitreal tPA and gas appear safe and effective as a treatment for traumatic SMHs. Furthermore, our results demonstrate that prompt treatment leads to favorable anatomical and functional outcomes.