Título / Title

YAG laser and tPA intravitreal versus vitrectomy and gas SF6 in the treatment of pre retinal and intrarretinal hemorraghe simultaneous. What is the best choice? Teaching a case

Introdução / Purpose

Retinal hemorrhages are retinopathies that result in some specific type of ocular blood leakage. The etiology is very variable. Individualized treatment should consider location and extent. One of these treatments is the intravitreal injection of tPA (tissue plasminogen activator).

Material e Método / Methods

Patient J.A.B.F., 36 years old, white with sudden low visual acuity in the left eye. Diagnosed with extensive preretinal hemorrhage (level) over the macular region, clearly delimited by the hyaloid, in addition to tortuous vessels. Hyaloid perforation was performed with Yag Laser, 10mJ/shot (40mJ/procedure) with centralis lens Volk without intercurrences. Intravitreal injection of tPA was indicated, however, the patient opted for vitrectomy via pars plana with 20% SF6 expander gas injection and no intravitreal tPA was used.

Resultados / Results

Total remission of pre retinal hemorraghe of yag laser

Discussão e Conclusões / Conclusion

The reported case presents a patient with spontaneous preretinal and retinal hemorrhage, due to probable rupture of a macroaneurysm, given the tortuosity of the vessels of this eye. Wouldn't just intravitreal injection of tPA be sufficient in this case, since the hyaloid was perforated? ³ Was the vitrectomy causing additional trauma, since there was another less invasive therapeutic possibility? This case is an invitation to reflect on quaternary prevention in ophthalmology. It is urgent to think that, in a context such as the Brazilian one, where vitrectomy is not widely accessible, indicating surgery, when other possibilities can be tried, is synonymous with distancing the patient from care.

Palavras Chave

Yag laser tPA intravitreal preretinal retinal hemorrhage vitrectomy

Area

CLINICAL RETINA