Pneumatic displacement with recombinant intravitreal tissue plasminogen activator (rTPA) versus vitrectomy with subretinal rTPA for submacular haemorrhage secondary to neovascular age related macular degeneration:A dual centre comparative case series

Session Details

Session Title: Free Paper Session 8: Vitreoretinal Surgery III

Session Date/Time: Friday 08/09/2017 | 08:00-09:30

Paper Time: 09:12

Venue: Room 111

First Author: : J.Ching UK

Co Author(s): :    J. Cardoso   R. Cabrera   A. Grabowska   N. Karia   S. Saidkasimova   A. Chandra              

Abstract Details

Purpose:

To compare the efficacy of pneumatic displacement with intravitreal recombinant tissue plasminogen activator (rTPA) [Group 1] versus vitrectomy with subretinal injection of rTPA with/without anti-VEGF [Group 2] for submacular haemorrhage in patients with neovascular age related macular degeneration (nAMD) in two tertiary referral centres.

Setting:

Two tertiary referral centres serving similar populations within the East of England, United Kingdom.

Methods:

Retrospective analysis of thirty consecutive patients presenting with submacular haemorrhage (SMH) and treated with the aforementioned regimens in two surgical units between June 2012 to October 2016. The primary outcome measure was SMH displacement. Secondary outcomes included best corrected visual acuity (BCVA) change post operatively, SMH height, SMH area, number of intravitreal anti-VEGF injections pre and post operatively, and surgical complications. Optical coherence tomography (OCT) images and clinical data were used to analyse outcomes.

Results:

Eleven patients were included in Group 1 and 19 patients in Group 2. Haemorrhagic displacement was complete in 9 (82.8%) out of 11 and 18 (94.7%) out of 19 patients in Groups 1 and 2, demonstrating no difference between them (p = 0.536). BCVA improved by -0.50 ± 0.74 (p = 0.045) and -0.72 ± 0.93 (p = 0.004) compared to baseline at 6 months in Groups 1 and 2, where there was no difference between groups (p = 0.155). Subfoveal haemorrhage height reduced in both groups (Group 1: -900.57μm, p = 0.007; Group 2: -607.27μm, p < 0.001), although no difference was demonstrated between groups (p = 0.582). SMH area reduced significantly in Group 2 but not 1 (Group 1: -44.18μm, p = 0.078; Group 2: -30.28μm, p <0.001), with no difference between groups (p = 0.913).

Conclusions:

Intravitreal treatment and vitrectomy were equally effective at displacing SMH from the fovea. BCVA gains did not differ significantly between intravitreal and vitrectomy techniques in patients treated for fovea involving submacular haemorrhage with underlying age related macular degeneration. OCT data demonstrated similar efficacy in both techniques. This data supports the use of either intravitreal or vitrectomy treatment as a first line therapy for nAMD.

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