Vitrectomy and intravitreal tissue plasminogen activator for sub-foveal haemorrhage secondary to wet age-related macular degeneration

Session Details

Session Title: Free Paper Session 26: Vitreoretinal Surgery VI

Session Date/Time: Sunday 10/09/2017 | 10:00-11:30

Paper Time: 10:54

Venue: Room 116

First Author: : T.Papathomas UK

Co Author(s): :    K. Kaprinis   S. Lash   R. Newsom                       

Abstract Details

Purpose:

To evaluate the efficacy and safety of vitrectomy and intravitreal tissue plasminogen activator (tPA) for the management of sub-foveal haemorrhage secondary to wet age related macular degeneration (wet-ARMD).

Setting:

Eye Unit, Southampton University Hospital, Southampton, United Kingdom.

Methods:

Retrospective case series of patients with sub-foveal haemorrhage secondary to wet-ARMD in the last year managed with 23 gauge pars plana vitrectomy followed by fluid to air exchange and tPA (30μg in 0.03 ml) into the vitreous cavity. All patients were subjected to supine position for 2 hours postoperatively, with no posturing required afterwards. Full ophthalmic examination and optical coherence tomography scans were performed at baseline, 2 weeks postoperatively and then monthly. Functional outcome was evaluated using best-corrected logMAR visual acuity (BCVA) whereas the anatomical outcome was determined with regards of the haemorrhage displacement (total, partial or none) as well as any scarring formation. Paired samples t-test was used to compare mean BCVA at different visits (SPSS 22.0 for windows).

Results:

Seven eyes (7 patients) were recorded having vitrectomy and intravitreal tPA for sub-foveal haemorrhage. Four out of 7 eyes had previous treatment with anti-vascular endothelial growth factor intravitreal injections. Mean age of the patient was 82.6 ± 5.7 years. Mean follow-up was 18.4 weeks (range 10 – 28 weeks). Mean BCVA at baseline was 1.84 ± 0.94. Mean BCVA increased at 1.4 ± 0.86 (t = 1.3, p = 0.24) at 2 weeks and reached at 0.95 ± 0.6 (t = 3.45, p = 0.014) at their final visit. Total displacement of the haemorrhage was achieved in 4 eyes (57%) and partial in the remaining 3 eyes (43%). No intraoperative complications were noted. High intraocular pressure was noted in 1 eye and 1 eye presented at 2 weeks with vitreous haemorrhage which self-cleared. No retinal detachment or endophthalmitis was recorded.

Conclusions:

According to this study vitrectomy and intravitreal tPA seems to be an effective and safe technique for the management of sub-foveal haemorrhage secondary to wet-ARMD.

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