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Woohyok Chang, Chan Ho Cho, Min Sagong, Hyun Ju Oh, Jae Whi Park, Dong Geun Park, Mi Rae Kim, Won Mo Gu, Jun Hyuk Son; Pars Plana Vitrectomy, Subretinal Injection of Recombinant Tissue Plasminogen Activator and Intraocular Gas Tamponade for Thick Submacular Hemorrhage with Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4083.
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To evaluate the efficacy of pars plana vitrectomy, subretinal injection of tissue plasminogen activator (t-PA) and intraocular gas tamponade for thick submacular hemorrhage caused by polypoidal choroidal vasculopathy.
Retrospective review of 13 eyes of 13 consecutive patients with polypoidal choroidal vasculopathy and thick submacular hemorrhage who underwent pars plana vitrectomy with subretinal t-PA injection and fluid-gas (20% SF6) exchange with postoperative facedown positioning. Outcome measures included degree of blood displacement from the fovea, postoperative corrected visual acuity.
All patients were followed for a minimum of 3 months. (mean 6.8 months, range 3 to 20). The mean age was 63.9 years, and the average symptom duration of submacular hemorrhage before surgery was 16.2 days. In all 13 eyes, the procedure resulted in complete displacement of thick submacular hemorrhage from the fovea within 1 month. Mean preoperative visual acuity at baseline was 20/893 (1.65±0.92 logMAR). The visual acuity improved to 20/252 (1.10±0.84 logMAR, p=0.085) at month one, 20/148 (0.87±0.87 logMAR, p=0.019) at month 3 and 20/142 (0.85±1.00 logMAR, p=0.019) at final visit. The polyp was located in the macular region in 10 eyes (76.9%) and extramacular region in 3 eyes (23.1%), which was identified by postoperative indocyanine green angiography. No significant correlation was found between location of polypoidal lesion and postoperative final visual acuity. (p=0.573) Postoperative complications included one case of rebleeding and one case of retinal pigment epithelium tear.
Pars plan vitrectomy with subretinal t-PA injection and gas tamponade was found to be relatively effective procedure for displacement of thick submacular hemorrhage with a significant visual acuity improvement in patients with polypoidal choroidal vasculopathy.
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