Surgical management of submacular haemhorrage due to AMD : a direct comparison between intravitreal and subretinal administration of rt PA in combination with 23 G PPV, pneumatic displacement and intravitreal injection of Avastin

Session Details

Session Title: Free Paper Session 27: AMD VI

Session Date/Time: Sunday 10/09/2017 | 12:00-13:30

Paper Time: 12:18

Venue: Room 117

First Author: : C.Skevas GERMANY

Co Author(s): :                                 

Abstract Details

Purpose:

To compare and assess the efficacy of subretinal vs intravitreal injection of recombinant tissue plasminogen activator (rt PA) in combination with pars plana vitrectomy (PPV), intravitreal injection of bevacizumab and pneumatic displacement of intravitreal injection with gas (Hexafluorethan-C2F6). Principal outcome measures were displacement of haemhorrage, visual acuity and macular thickness.

Setting:

The study was performed at the university clinic Eppendorf in Hamburg

Methods:

Nonrandomized, retrospective, interventional, comparative consecutive series including 42 patients with submacular haemhorrage. All patients were treated with PPV, intravitreal injection of 1.25 mg bevacizumab and pneumatic displacement with intravitreal injection of C2F6 gas. Of the 42 patients treated, 24 patients (n = 24) were treated with subretinal injection of rtPA (group A) and 18 patients (n=18) received an intravitreal injection of rt PA (group B). The patients maintained a face down position for 1 to 3 days. Macular thickness volume was measured with spectral domain optical coherence tomography.

Results:

The average interval from the onset of symptoms to surgery was 9.1 ±4.6 days, and the average size of the subretinal haemhorrage was 4.5±1.0 disc diameters. The submacular haemhorrage was displaced from the foveal area in all eyes after 1 week. Volume reduction of subretinal blood at 4 weeks postoperatively was more pronounced in group A than group B. In group A, mean best-corrected visual acuity (BCVA) change was logMAR 0.8, and in group B logMAR 1.0, without statistically significant difference between the two groups (Mann–Whitney test). There were no intraoperative complications (retinal detachment, vitreous haemhorrage, and recurrence of submacular haemhorrage).

Conclusions:

PPV with pneumatic displacement, intravitreal injection of bevacizumab and rt PA injection (intravitreal and subretinal) is a useful treatment option for acute submacular haemhorrage (ASH). Both methods showed a complete displacement of bleeding. Subretinal injection of rt PA showed no advantage in terms of visual acuity improvement compared to intravitreal injection but led to a marked improvement of retinal volume compared to intravitreal injection. Functional improvement in the majority of patients suggests the absence of direct retinal toxicity of subretinally applied rtPA.

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