Materials and Methods: The study included 10 eyes of 10 patients who underwent subretinal r-tPA injection with 23 G PPV due to SMH extending towards the fovea. Following standard 23 G PPV, r-tPA (Actilyse, 10 mg/mL, Boehringer-Ingelheim, Germany) at a concentration of 25 ?g/0.1 ml was injected into the subretinal space with a 41 G needle at a concentration of 0.2-0.3 ml. Subsequently, fluid-air-12% C3F8 exchange was performed and intravitreal 1.25 mg bevacizumab was administered. After surgery, the patient was given appropriate head position according to the bleeding site.

Results: The mean age of the patients was 73.9 ± 4.7 years, 4 (40%) were male and 6 (60%) were female. Two patients (20%) developed SMH due to retinal macroaneurysm rupture, while choroidal neovascular membrane was the cause of hemorrhage in 8 patients (80%). Best corrected visual acuity was 2.53 ± 0.49 logMAR preoperatively, 1.28 ± 0.66 at one month, 1.08 ± 0.64 at three months and 1.04 ± 0.62 at six months postoperatively and the difference was significant (p<0.001 for each parameter).

Conclusions: In patients with submacular hemorrhage, r-tPA administered subretinally provides significant visual acuity improvement without serious complications. Keywords : Pars plana, recombinant tissue plasminogen activator r-tPA, submacular hemorrhage, subretinal injection