Supplementary Material for: Early drainage of macula-involving massive suprachoroidal haemorrhage assisted with recombinant tissue plasminogen activator may lead to better visual prognosis

Introduction: A massive suprachoroidal haemorrhage (SCH) is a devastating complication with significant morbidity and poor visual and anatomic outcome. Conventional management is to observe for 7-14 days before surgical drainage. However, permanent structural changes in the retina can occur within this timeframe. Suprachoroidal injection of recombinant tissue plasminogen activator may speed up clot breakdown and aid early surgical drainage. We present a case series of macula-involving massive SCH treated with early drainage aided by r-tPA.

Case presentation: Retrospective case series of three patients with macula involving massive SCH treated with suprachoroidal r-tPA within 24 hours of bleed and early drainage of SCH within 48 hours of r-tPA injection, combined with vitrectomy and tamponade. 100µg of recombinant tissue plasminogen activator was injected into the suprachoroidal haemorrhage 24 hours following initial injury in all patients. Drainage of the SCH was then performed 6-48 hours after the injection of r-tPA. Early drainage was successful and visual improvement was seen in all patients. One patient had a recurrence of SCH but was successfully re-treated.

Conclusion: The technique of r-tPA assisted early drainage of SCH is safe and has promising potential to restore visual function in patients with macula involving massive SCH. Our small sample would indicate that 100μg/0.4ml of r-tPA injected within 24 hours of bleed allows surgical drainage of suprachoroidal haemorrhage as early as day 2 post initial injury. Larger studies are required to investigate further which patients are likely to benefit from this treatment.