EJO ISSN 1120-6721 European Journal of Ophthalmology 2018, Vol. 28(3) 306–310 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.5301/ejo.5001074 journals.sagepub.com/home/ejo ORIGINAL RESEARCH ARTICLE (VA) loss of 3 lines within 3 years and a fnal VA of less than 20/200 in 53% of cases (1). Currently, there is no standard treatment for SMH associ- ated with nAMD. Many treatment optons for SMH have been reported, including intravitreal (IV) ant-vascular endothelial growth factor (VEGF) agent; pneumatc displacement (PD), either with (5, 6) or without IV tssue plasminogen actvator (tPA) (7, 8); IV injecton of tPA, gas, and ant-VEGF agent (9, 10); surgical removal of hematoma, with (11) or without (12) removal of the choroidal neovascular membrane (CNVM); pars plana vitrectomy (PPV) with tPA-assisted PD (11, 13); and subretnal tPA and an ant-VEGF agent (14, 15). In clinical practce, tPA and ant-VEGF are generally co-ap- plied with PD. The in vivo compatbility of co-applied tPA and ant-VEGF is not exactly known, and IV gas in the facedown posi- ton may decrease the amount of drugs that reach the target ts- sue. Therefore, we have been implementng sequental use of IV tPA, PD, and IV ant-VEGF treatment for SMH since June 2014. In this study, we aimed to report our results for sequen- tal IV tPA, PD, and IV ant-VEGF treatment in patents with nAMD-related SMH. Our results may be helpful for further studies. Sequental tssue plasminogen actvator, pneumatc displacement, and ant-VEGF treatment for submacular hemorrhage Handan Bardak, Yavuz Bardak, Yeşim Erçalık, Burak Erdem, Gökhan Arslan, Semrin Timlioglu Department of Ophthalmology, Haydarpasa Numune Training and Research Hospital, Istanbul - Turkey Introducton Submacular hemorrhage (SMH) is a common manifes- taton of neovascular age-related macular degeneraton (nAMD) and may cause sudden and severe decrease of vision (1). The visual prognosis is poor in nAMD-related SMH (2) due to retnal damage. The retnal damage is caused by underly- ing neovascular degeneratve processes (2), iron toxicity (3), difusion barriers, and clot retracton (4). The natural history of the conditon is characterized by an expected visual acuity ABSTRACT Purpose: To report the results of our sequental intravitreal (IV) tssue plasminogen actvator (tPA), pneumatc displacement (PD), and IV ant-vascular endothelial growth factor (VEGF) treatment in patents with neovascular age-related macular degeneraton (nAMD)-related submacular hemorrhage (SMH). Methods: A total of 16 eyes of 16 patents with SMH of less than 15 days duraton were included in this retrospec- tve pilot study. The tPA was applied on the day of diagnosis, and PD was performed the following day. Patents received 3 consecutve monthly IV injectons of ranibizumab startng from 15 days afer PD. During the follow-ups, additonal ranibizumab treatment was performed if persistent macular or recurrent subretnal or intraretnal fuid hemorrhage was observed. Results: The mean central retnal thickness was 489 ± 92 μm (311-621 μm) at the tme of diagnosis, 324 ± 56 μm (209-409 μm) at the frst month, 262 ± 48 μm (197-364 μm) at 3 months, 248 ± 40 μm (190-334 μm) at 6 months, and 253 ± 41 μm (192-356 μm) at the last control (p<0.01). The mean best-corrected visual acuity was 2.08 ± 0.79 logMAR (0.7-3.0 logMAR) at baseline, 1.41 ± 0.70 logMAR (0.56-2.50 logMAR) at the frst month, 1.21 ± 0.66 log- MAR (0.3-2.0 logMAR) at 3 months, 1.14 ± 0.77 logMAR (0.2-2.50 logMAR) at 6 months, and 1.09 ± 0.73 logMAR (0.3-2.50 logMAR) at the last follow-up (p<0.01). Conclusions: Sequental IV tPA, PD, and IV ant-VEGF treatments for SMH in patents with nAMD is efectve. However, further studies are needed to establish the best treatment algorithm for SMH in patents with nAMD. Keywords: Ant-vascular endothelial growth factor, Neovascular age-related macular degeneraton, Pneumatc displacement, Submacular hemorrhage, Tissue plasminogen actvator Accepted: October 16, 2017 Published online: November 4, 2017 Corresponding author: Dr. Handan Bardak Department of Ophthalmology Haydarpasa Numune Training and Research Hospital Uskudar 34668 Istanbul, Turkey handanbardak@yahoo.com.tr