What happens to choroidal neovascularization after recombinant tissue plasminogen activator intravitreal injection?

Session Details

Session Title: Free Paper Session 3: AMD I

Session Date/Time: Thursday 07/09/2017 | 08:30-10:00

Paper Time: 08:48

Venue: Room 118

First Author: : I.D'Agostino ITALY

Co Author(s): :    M. Cereda   G. Staurenghi                          

Abstract Details

Purpose:

To evaluate long term visual outcome and progression of exudative age related macular degeneration (wet-AMD) in terms of choroidal neovascularization (CNV) activity and OCT B-Scan changes in patients treated with intravitreal injection of recombinant tissue plasminogen activator (rTPA) for recent onset of submacular haemhorrage.

Setting:

This is a retrospective case series of patients diagnosed with exudative age related macular degeneration complicated with submacular haemhorrage treated at “Luigi Sacco Hospital” Eye Clinic, Department of Biomedical and Clinical Science, University of Milan from May 2013 to October 2015.

Methods:

This is a retrospective case series of 25 patients diagnosed with submacular haemhorrage associated with CNV and treated by intravitreal rTPA (50mg in 0.1ml) and gas (0.3cc SF699%). In all patients included in our revision the procedure was performed within 14 days from bleeding and an anti-VEGF drug was injected in each eye at the day of diagnosis and preceded the pneumatic displacement from 1 to 5 days. We included eyes that were scanned with SD-OCT(HRA Spectralis, Heidelberg Engineering) at baseline, one day, one week and one month after the main procedure; for anti-VEGF intravitreal injections, a pro re nata (PRN) approach was used thereafter in all patients selected. We evaluated visual acuity (VA) registered before and after displacement , CNV reactivation and number of anti-VEGF intravitreal injections necessary in the following years.

Results:

At baseline the mean VA was 0.9 LogMar (SD ±0.3) and rise to 0.7 LogMar (SD ±0.4) at first evaluation after the injection. Ten patients didn't require further treatments because of CNV contraction and poor residual VA (mean 1.3 LogMar, SD ±0.2), a complete blood dislocation was obtained just in 3 of them. Eleven patients showed a VA improvement from 0.7 LogMar (DV ±0.3) to 0.5 LogMar (DV ±0.3) associated with a complete (7/11) o partial (4/11) dislocation of the haemhorrage from macula within 7 days. In eight of them further anti-VEGF intravitreal injections were necessary during the follow up (mean number of injections was 5.5 in the first year,2.7 per year during follow up), while in 3 patients CNV didn’t show other signs of activity. We lost 4 patients at follow up visits. Mean follow up time was 19,8 months (max 39,min 4). In one case vitreous haemhorrage complicated the main procedure.

Conclusions:

In our series, BCVA correlated with a complete dislocation of the submacular haemhorrage within 7 days. When procedure failed a fibrotic contraction of the CNV occurred and VA outcome was poor. After a complete dislocation of the blood CNV can reactivate. Rate of reactivation is higher during the first year and tends to reduce thereafter.

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