Microscope-Integrated OCT–Guided Console-Controlled Subretinal rtPA Delivery for Traumatic Submacular Hemorrhage in a Highly Myopic Eye

PURPOSE: To report the management of traumatic submacular hemorrhage (SMH) in a highly myopic eye using early pars plana vitrectomy and low-dose subretinal recombinant tissue plasminogen activator (rtPA) delivered with a console-controlled micro-dosing system under microscope-integrated optical coherence tomography (iOCT) guidance. METHODS: A 36-year-old man with high myopia (-15.00 D) presented with acute traumatic SMH and severe visual loss. He underwent combined phacoemulsification and pars plana vitrectomy with internal limiting membrane peeling. Subretinal rtPA (25 μg/0.1 mL) was delivered through a 38-gauge cannula using a viscous fluid control-based injector assembled from standard sterile components. iOCT was used to confirm retinotomy position, subretinal placement, and bleb formation. Fluid-air exchange and 12% C3F8gas tamponade completed the procedure. RESULTS: The hemorrhage displaced progressively and resorbed over follow-up. Best-corrected visual acuity improved from counting fingers at presentation to 0.4 at 1 month and 0.7 at 3 months, remaining stable at 6 months. Optical coherence tomography showed restoration of foveal contour with persistent outer retinal disruption. No intraoperative or postoperative complications were observed. CONCLUSION: In this case, iOCT-guided console-controlled micro-dosing enabled controlled subretinal rtPA delivery and effective displacement of traumatic SMH using nonproprietary instrumentation. This workflow may be useful when dedicated commercial microinjectors are unavailable.