Miscellanous – macroaneurysm, tumours, iatrogenic (surgical/laser), Valsalva retinopathy, DR.
Symptoms: Sudden painless loss of central vision with metamorphosia.
Investigation: OCT macula.
Prognosis factors for vision recovery:
Volume (thickness and extent)
Duration (within 1-2 weeks for intervention)
Pneumatic displacement (100% 0.3ml C3F8) + tPA (50 micrograms/0.1ml)
PPV + subretinal tPA + anti VEGF + gas
Preparation guide for Alteplase (tPA) 50 micrograms in 0.1ml IVT injection:
Use 10mg Actilyse
Add 10ml water for injection (provided with Actilyse pack) to 10ml Actilyse vial –> 1mg/ml solution
Shake vial to dissolve.
Use 1ml syringe – draw up 0.5ml from reconstituted vial.
Transfer to sterile vial.
Use fresh 1ml syringe and withdraw 0.5ml water.
Add the 0.5ml water into the 0.5ml reconstituted vial.
Mix well –> 500 micrograms in 1ml solution.
Administer 50 micrograms/0.1ml as IVT using a fresh 1ml syringe.