First Author: I.Kumar UK
Co Author(s): A. Kamal 0 0 0 0 0 0 0 0 0
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Sub-macular haemorrhage associated with wet AMD is a complication known to have potentially devastating effects on visual acuity. Various techniques involving vitrectomy with tissue plasminogen activator have been described in the literature. However, there remains no consensus on optimal treatment. We evaluated the efficacy and safety of fairly new combination technique of intravitreal SF6 and repeated intravitreal Lucentis injections in a non-vitrectomised eye for the resolution of SMH.
To evaluate the efficacy and safety of intravitreal SF6 and repeated intravitreal Lucentis injections in a non-vitrectomised eye for the resolution of SMH.
Prospective analysis was done of 15 eyes of 14 patients of SMH treated with intravitreal injection of absolute SF6 gas and 0.5mg Lucentis injections with anterior chamber paracentesis. Patients were postured in a prone position for 3 to 5 days. Post operatively, patients had 30% gas fill. Further treatment with intravitreal Lucentis was continued as required on the basis of clinical and OCT (Optical coherence tomography) findings. Average follow up was 3.5 months (range from 1 day to 12 months).
There were 9 women and 5 men with an average age of 78.9 years (range from 54 years to 95 years). There were 7 patients on anti-platelet drugs. Average duration of symptoms was 40 days ranging from 1 day to 210 days. Average size of haemorrhage was 6 disc diameters ranging from 1.5 to 23 disc diameters. SMH was completely displaced in 11 and partially displaced in 4 out of 15 eyes. Visual acuity (VA) improved or was stable in 12 and decreased in 3 eyes due to sub retinal fibrosis. Mean baseline VA of 33.9 letters on the LogMAR chart improved to 39.7 letters post operatively with mean VA improvement of 5.7 letters (p value 0.4). Mean baseline CMT (central macular thickness) of 501µm decreased to 380µm post operatively with mean CMT improvement of 121.8µm (p value 0.008). Six eyes developed high intraocular pressure at 60 minutes after the procedure which was controlled with a stat dose of Acetazolamide. Two patients developed cataracts.
This small pilot study has shown that SMH can be successfully and safely treated in non-vitrectomised eyes with intravitreal SF6. Major advantages of this treatment is avoidance of major procedures like pars plana vitrectomy and gas and minimising the risks associated with it and it is economical. To the best of our knowledge, this is the first study using SF6 gas in non-vitrectomised eyes for SMH in a good number of patients. Success of treatment depends on the duration and size of the haemorrhage. Its efficacy is comparable to extensive procedures involving vitrectomy and sub macular surgeries. Further studies are required to prove its efficacy and safety.