Introduction and importance: Case of secondary full-thickness macular hole occurring shortly after surgery for subretinal hemorrhage with the injection of tissue-type plasminogen activator (t-PA) is rare. Case Presentation: We report a case of a 70-year-old Chinese man who underwent vitrectomy combined with subretinal injection of t-PA for subretinal hemorrhage and subsequently developed a macular hole (MH). The patient presented with extensive sub-ILM and subretinal hemorrhage caused by a ruptured retinal arterial macroaneurysm (RAM). One week after the t-PA injection, a secondary full-thickness macular hole developed. The macular hole was successfully closed using autologous blood filling followed by silicone oil tamponade. Clinical Discussion: Subretinal injection of t-PA for treating subretinal hemorrhage may induce macular hole formation, which may occur intraoperatively or postoperatively. Several mechanisms may contribute to this complication, warranting careful use of t-PA. If a macular hole develops, autologous blood filling is a viable option for anatomical closure. Conclusion: Subretinal t-PA can cause early postoperative macular hole. If a macular hole develops, autologous blood filling is a viable option for anatomical closure.
Lv et al. (Fri,) studied this question.