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01.10.2012 | original article | Ausgabe 4/2012

Spektrum der Augenheilkunde 4/2012

Limited vitrectomy with intravitreal bevacizumab, rt-PA and gas for submacular hemorrhage due to age-related macular degeneration

Spektrum der Augenheilkunde > Ausgabe 4/2012
MD Dr. Lisa Tarmann, Andreas Wedrich, MD Anton Haas, PhD Andrea Berghold, PhD Adelheid Kresse, Christian Vajda, MD Richard Maier



To investigate the safety and efficacy of limited vitrectomy with intravitreal bevacizumab, recombinant tissue plasminogen activator (rt-PA) and gas for displacement of submacular hemorrhage due to exudative age-related macular degeneration (AMD).


In this retrospective pilot study 11 eyes of 11 patients with submacular hemorrhage secondary to AMD were analyzed.
A limited 23 g-one-port pars plana vitrectomy was performed and 50 μg rt-PA, 1.25 mg bevacizumab and about 1.5 mL of 100 % sulfur hexafluoride (SF6) were injected into the vitreous. The best and the final visual acuity and blood displacement from the fovea were evaluated postoperatively.


The best postoperative visual acuity (VA) was obtained at a median of 1 month after surgery (range 0.5–6 months) and demonstrated significantly better results than baseline VA for a short period of time (p = 0.04). No statistically significant improvement (p = 0.11) of the final visual acuity at a median of 3 months (range 0.5–6 months) compared to preoperative was found. Final visual acuity improved in 7 eyes, remained stable in 2 eyes and worsened in 2 eyes. Total pneumatic displacement of the submacular hemorrhage was obtained in 5 (46 %) eyes, partial displacement was shown in 2 (18 %) eyes. There was no displacement of the subretinal hemorrhage in 4 (36 %) eyes.


This surgical procedure seems to have no advantage over intravitreous injection of rt-PA and gas with or without complete vitrectomy concerning displacement rate of submacular hemorrhage and postoperative visual acuity.

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