First Author: S.Sukavatcharin THAILAND
Co Author(s): N. Tranti W. Prasartritta R.C. Olarn 0 0 0 0 0 0 0 0 0
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To compare outcome of subretinal injection of tissue plasminogen activator (tPA) combined with intravitreal bevazicumab injection in the treatment of thick submacular hemorrhage
Ramathibodi Hospitial, Mahidol University, Bangkok, Thailand
Retrospective comparative case study of 40 eyes of 40 patients presenting with thick submacular hemorrhage from Aged-related macula degeneration (AMD) or Idiopathic polypoidal choroidal vasculopathy (IPCV). Group 1 (20 patients) were treated with pars plana vitrectomy, subretinal injection of tPA (25-50 µg), intravitreal bevazicumab (1.25mg/0.05 ml) injection and partial fluid-air(or fluid-gas) exchange followed by 1-day face-down or upright positioning. Group 2 (20 patients) were treated with pneumatic retinopexy with perfluoropropane gas with or without tPA/anti-VEGF intravitreal injection. Patient demographics, diagnosis, visual acuity, duration of follow up, displacement of hemorrhage from the fovea, and any late post operative complication were obtained.
There were F:M 7:13 in group 1 and 9:11 in group 2. The preoperative BCVA ranged from HM-20/50 (mean = 20/400) in both group. Postoperatively, submacular hemorrhage was totally displaced from fovea in 80% of the patients in group 1 and none in group 2 at 1 month with statistic significant. Best postoperative visual acuity at 6 months varied from CF to 20/20 (median =20/50), with improvement noted in 17 cases (85%) in group 1 and VA ranged from HM to 20/30 (median = 20/100) with VA improvement in 50% in group 2. BCVA of > 20/40 was achieved in 8 patients (40%) in group 1 while 2 patients (10%) in group 2. Mean postoperative follow-up was 1.1 year (range, 2 months to 2.6 years) in both groups.
These results showed that subretinal injection of tPA combined with intravitreal bevazicumab injection have favorable subretinal blood displacement and faster visual improvement if compare to pneumatic displacement method.