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Erschienen in: Spektrum der Augenheilkunde 4/2012

01.10.2012 | original article

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

verfasst von: Dr. Lisa Tarmann, MD, Andreas Wedrich, Anton Haas, MD, Andrea Berghold, PhD, Adelheid Kresse, PhD, Christian Vajda, Richard Maier, MD

Erschienen in: Spektrum der Augenheilkunde | Ausgabe 4/2012

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Summary

Purpose

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).

Methods

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.

Results

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.

Conclusion

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.
Literatur
1.
Zurück zum Zitat Avery RL, Fekrat S, Hawkins BS, et al. Natural history of subfoveal subretinal hemorrhage in age-related macular degeneration. Retina. 1996;16(3):183–9.PubMedCrossRef Avery RL, Fekrat S, Hawkins BS, et al. Natural history of subfoveal subretinal hemorrhage in age-related macular degeneration. Retina. 1996;16(3):183–9.PubMedCrossRef
2.
Zurück zum Zitat Toth CA, Morse LS, Hjelmeland LM, et al. Fibrin directs early retinal damage after experimental subretinal hemorrhage. Arch Ophthalmol. 1991;109(5):723–9.PubMedCrossRef Toth CA, Morse LS, Hjelmeland LM, et al. Fibrin directs early retinal damage after experimental subretinal hemorrhage. Arch Ophthalmol. 1991;109(5):723–9.PubMedCrossRef
3.
Zurück zum Zitat Gillies A, Lahav M. Absorption of retinal and subretinal hemorrhages. Ann Ophthalmol. 1983;15(11):1068–74.PubMed Gillies A, Lahav M. Absorption of retinal and subretinal hemorrhages. Ann Ophthalmol. 1983;15(11):1068–74.PubMed
4.
Zurück zum Zitat Scupola A, Coscas G, Soubrane G, et al. Natural history of macular subretinal hemorrhage in age-related macular degeneration. Ophthalmologica. 1999;213(2):97–102.PubMedCrossRef Scupola A, Coscas G, Soubrane G, et al. Natural history of macular subretinal hemorrhage in age-related macular degeneration. Ophthalmologica. 1999;213(2):97–102.PubMedCrossRef
5.
Zurück zum Zitat Bennett SR, Folk JC, Blodi CF, et al. Factors prognostic of visual outcome in patients with subretinal hemorrhage. Am J Ophthalmol. 1990;109(1):33–7.PubMed Bennett SR, Folk JC, Blodi CF, et al. Factors prognostic of visual outcome in patients with subretinal hemorrhage. Am J Ophthalmol. 1990;109(1):33–7.PubMed
6.
Zurück zum Zitat Guthoff R, Guthoff T, Meigen T, et al. Intravitreous injection of bevacizumab, tissue plasminogen activator, and gas in the treatment of submacular hemorrhage in age-related macular degeneration. Retina. 2011;31(1):36–40. Guthoff R, Guthoff T, Meigen T, et al. Intravitreous injection of bevacizumab, tissue plasminogen activator, and gas in the treatment of submacular hemorrhage in age-related macular degeneration. Retina. 2011;31(1):36–40.
7.
Zurück zum Zitat Krepler K, Kruger A, Tittl M, et al. Intravitreal injection of tissue plasminogen activator and gas in subretinal hemorrhage caused by age-related macular degeneration. Retina. 2000;20(3):251–6.PubMedCrossRef Krepler K, Kruger A, Tittl M, et al. Intravitreal injection of tissue plasminogen activator and gas in subretinal hemorrhage caused by age-related macular degeneration. Retina. 2000;20(3):251–6.PubMedCrossRef
8.
Zurück zum Zitat Oshima Y, Ohji M, Tano Y. Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage. Br J Ophthalmol. 2007;91(2):193–8.PubMedCrossRef Oshima Y, Ohji M, Tano Y. Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage. Br J Ophthalmol. 2007;91(2):193–8.PubMedCrossRef
9.
Zurück zum Zitat Hillenkamp J, Surguch V, Framme C, et al. Management of submacular hemorrhage with intravitreal versus subretinal injection of recombinant tissue plasminogen activator. Graefes Arch Clin Exp Ophthalmol. 2010;248(1):5–11.PubMedCrossRef Hillenkamp J, Surguch V, Framme C, et al. Management of submacular hemorrhage with intravitreal versus subretinal injection of recombinant tissue plasminogen activator. Graefes Arch Clin Exp Ophthalmol. 2010;248(1):5–11.PubMedCrossRef
10.
Zurück zum Zitat Hassan AS, Johnson MW, Schneiderman TE, et al. Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement. Ophthalmology. 1999;106(10):1900–6; discussion 1906–7.PubMedCrossRef Hassan AS, Johnson MW, Schneiderman TE, et al. Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement. Ophthalmology. 1999;106(10):1900–6; discussion 1906–7.PubMedCrossRef
11.
Zurück zum Zitat Hesse L, Kroll P. Successful treatment of acute subretinal hemorrhage in age-related macular degeneration by combined intravitreal injection of recombinant tissue plasminogen activator and gas. Adv Ther. 1997;14(5):275–80.PubMed Hesse L, Kroll P. Successful treatment of acute subretinal hemorrhage in age-related macular degeneration by combined intravitreal injection of recombinant tissue plasminogen activator and gas. Adv Ther. 1997;14(5):275–80.PubMed
12.
13.
Zurück zum Zitat Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109(10):1814–20.PubMedCrossRef Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109(10):1814–20.PubMedCrossRef
14.
Zurück zum Zitat Haas A, Seidel G, Steinbrugger I, Maier R, Gasser-Steiner V, Wedrich A, Weger M. Twenty-three-gauge and 20-gauge vitrectomy in epiretinal membrane surgery. Retina. 2010; 30(1):112–6.PubMedCrossRef Haas A, Seidel G, Steinbrugger I, Maier R, Gasser-Steiner V, Wedrich A, Weger M. Twenty-three-gauge and 20-gauge vitrectomy in epiretinal membrane surgery. Retina. 2010; 30(1):112–6.PubMedCrossRef
15.
Zurück zum Zitat Lange C, Feltgen N, Junker B, et al. Resolving the clinical acuity categories “hand motion” and “counting fingers” using the Freiburg Visual Acuity Test (FrACT). Graefes Arch Clin Exp Ophthalmol. 2009;247(1):137–42.PubMedCrossRef Lange C, Feltgen N, Junker B, et al. Resolving the clinical acuity categories “hand motion” and “counting fingers” using the Freiburg Visual Acuity Test (FrACT). Graefes Arch Clin Exp Ophthalmol. 2009;247(1):137–42.PubMedCrossRef
16.
Zurück zum Zitat Schulze SD, Hesse L. Tissue plasminogen activator plus gas injection in patients with subretinal hemorrhage caused by age-related macular degeneration: predictive variables for visual outcome. Graefes Arch Clin Exp Ophthalmol. 2002;240(9):717–20.PubMedCrossRef Schulze SD, Hesse L. Tissue plasminogen activator plus gas injection in patients with subretinal hemorrhage caused by age-related macular degeneration: predictive variables for visual outcome. Graefes Arch Clin Exp Ophthalmol. 2002;240(9):717–20.PubMedCrossRef
17.
Zurück zum Zitat Mozaffarieh M, Heinzl H, Sacu S, et al. In-patient management and treatment satisfaction after intravitreous plasminogen activator injection. Graefes Arch Clin Exp Ophthalmol. 2006;244(11):1421–8.PubMedCrossRef Mozaffarieh M, Heinzl H, Sacu S, et al. In-patient management and treatment satisfaction after intravitreous plasminogen activator injection. Graefes Arch Clin Exp Ophthalmol. 2006;244(11):1421–8.PubMedCrossRef
18.
Zurück zum Zitat Hesse L, Schmidt J, Kroll P. Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas. Graefes Arch Clin Exp Ophthalmol. 1999;237(4):273–7.PubMedCrossRef Hesse L, Schmidt J, Kroll P. Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas. Graefes Arch Clin Exp Ophthalmol. 1999;237(4):273–7.PubMedCrossRef
19.
Zurück zum Zitat Handwerger BA, Blodi BA, Chandra SR, et al. Treatment of submacular hemorrhage with low-dose intravitreal tissue plasminogen activator injection and pneumatic displacement. Arch Ophthalmol. 2001;119(1):28–32.PubMed Handwerger BA, Blodi BA, Chandra SR, et al. Treatment of submacular hemorrhage with low-dose intravitreal tissue plasminogen activator injection and pneumatic displacement. Arch Ophthalmol. 2001;119(1):28–32.PubMed
20.
Zurück zum Zitat Hattenbach LO, Klais C, Koch FH, et al. Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions. Ophthalmology. 2001;108(8):1485–92.PubMedCrossRef Hattenbach LO, Klais C, Koch FH, et al. Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions. Ophthalmology. 2001;108(8):1485–92.PubMedCrossRef
21.
Zurück zum Zitat Meyer CH, Scholl HP, Eter N, et al. Combined treatment of acute subretinal haemorrhages with intravitreal recombined tissue plasminogen activator, expansile gas and bevacizumab: a retrospective pilot study. Acta Ophthalmol. 2008;86(5):490–4.PubMedCrossRef Meyer CH, Scholl HP, Eter N, et al. Combined treatment of acute subretinal haemorrhages with intravitreal recombined tissue plasminogen activator, expansile gas and bevacizumab: a retrospective pilot study. Acta Ophthalmol. 2008;86(5):490–4.PubMedCrossRef
22.
Zurück zum Zitat Arias L, Mones J. Transconjunctival sutureless vitrectomy with tissue plasminogen activator, gas and intravitreal bevacizumab in the management of predominantly hemorrhagic age-related macular degeneration. Clin Ophthalmol. 2010;4:67–72.PubMedCrossRef Arias L, Mones J. Transconjunctival sutureless vitrectomy with tissue plasminogen activator, gas and intravitreal bevacizumab in the management of predominantly hemorrhagic age-related macular degeneration. Clin Ophthalmol. 2010;4:67–72.PubMedCrossRef
23.
Zurück zum Zitat Auriol S, Mahieu L, Lequeux L, et al. Pars plana vitrectomy, subretinal injection of recombinant tissue plasminogen activator and fluid-gas exchange in the management of massive submacular hemorrhages secondary to age-related macular degeneration. J Fr Ophtalmol. 2010;33(2):84–91.PubMedCrossRef Auriol S, Mahieu L, Lequeux L, et al. Pars plana vitrectomy, subretinal injection of recombinant tissue plasminogen activator and fluid-gas exchange in the management of massive submacular hemorrhages secondary to age-related macular degeneration. J Fr Ophtalmol. 2010;33(2):84–91.PubMedCrossRef
24.
Zurück zum Zitat Haupert CL, McCuen BW 2nd, Jaffe GJ, et al. Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration. Am J Ophthalmol. 2001;131(2):208–15.PubMedCrossRef Haupert CL, McCuen BW 2nd, Jaffe GJ, et al. Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration. Am J Ophthalmol. 2001;131(2):208–15.PubMedCrossRef
25.
Zurück zum Zitat Singh RP, Patel C, Sears JE. Management of subretinal macular haemorrhage by direct administration of tissue plasminogen activator. Br J Ophthalmol. 2006;90(4):429–31.PubMedCrossRef Singh RP, Patel C, Sears JE. Management of subretinal macular haemorrhage by direct administration of tissue plasminogen activator. Br J Ophthalmol. 2006;90(4):429–31.PubMedCrossRef
26.
Zurück zum Zitat Treumer F, Klatt C, Roider J, et al. Subretinal coapplication of recombinant tissue plasminogen activator and bevacizumab for neovascular age-related macular degeneration with submacular haemorrhage. Br J Ophthalmol. 2010;94(1):48–53.PubMedCrossRef Treumer F, Klatt C, Roider J, et al. Subretinal coapplication of recombinant tissue plasminogen activator and bevacizumab for neovascular age-related macular degeneration with submacular haemorrhage. Br J Ophthalmol. 2010;94(1):48–53.PubMedCrossRef
27.
Zurück zum Zitat Olivier S, Chow DR, Packo KH, et al. Subretinal recombinant tissue plasminogen activator injection and pneumatic displacement of thick submacular hemorrhage in Age-Related macular degeneration. Ophthalmology. 2004;111(6):1201–8.PubMedCrossRef Olivier S, Chow DR, Packo KH, et al. Subretinal recombinant tissue plasminogen activator injection and pneumatic displacement of thick submacular hemorrhage in Age-Related macular degeneration. Ophthalmology. 2004;111(6):1201–8.PubMedCrossRef
28.
Zurück zum Zitat Krebs I, Brannath W, Glittenberg C, et al. Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration? Am J Ophthalmol. 2007;144(5):741–6. Krebs I, Brannath W, Glittenberg C, et al. Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration? Am J Ophthalmol. 2007;144(5):741–6.
29.
Zurück zum Zitat Verma D, Jalabi MW, Watts WG, et al. Evaluation of posturing in macular hole surgery. Eye (Lond). 2002;16(6):701–4.CrossRef Verma D, Jalabi MW, Watts WG, et al. Evaluation of posturing in macular hole surgery. Eye (Lond). 2002;16(6):701–4.CrossRef
30.
Zurück zum Zitat Lincoff H, Kreissig I, Stopa M, et al. A 40 degrees gaze down position for pneumatic displacement of submacular hemorrhage: clinical application and results. Retina. 2008;28(1):56–9.PubMedCrossRef Lincoff H, Kreissig I, Stopa M, et al. A 40 degrees gaze down position for pneumatic displacement of submacular hemorrhage: clinical application and results. Retina. 2008;28(1):56–9.PubMedCrossRef
31.
Zurück zum Zitat Stopa M, Lincoff A, Lincoff H. Analysis of forces acting upon submacular hemorrhage in pneumatic displacement. Retina. 2007;27(3):370–4.PubMedCrossRef Stopa M, Lincoff A, Lincoff H. Analysis of forces acting upon submacular hemorrhage in pneumatic displacement. Retina. 2007;27(3):370–4.PubMedCrossRef
Metadaten
Titel
Limited vitrectomy with intravitreal bevacizumab, rt-PA and gas for submacular hemorrhage due to age-related macular degeneration
verfasst von
Dr. Lisa Tarmann, MD
Andreas Wedrich
Anton Haas, MD
Andrea Berghold, PhD
Adelheid Kresse, PhD
Christian Vajda
Richard Maier, MD
Publikationsdatum
01.10.2012
Verlag
Springer Vienna
Erschienen in
Spektrum der Augenheilkunde / Ausgabe 4/2012
Print ISSN: 0930-4282
Elektronische ISSN: 1613-7523
DOI
https://doi.org/10.1007/s00717-012-0119-4

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