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yu kozaki, Masayo Kimura, Tsutomu Yasukawa, Shinpei Fujino, Hiroshi Morita, Aki Kato, Munenori Yoshida, Yuichiro Ogura; Pneumatic displacement of submacular hemorrhage associated with age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2846.
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© ARVO (1962-2015); The Authors (2016-present)
Tissue plasminogen activator (tPA) is a fibrinolytic compound, utilized as an adjuvant for displacement of submacular hemorrhage. Intravitreal injection of sulfur hexafluoride (SF6) gas with tPA for submacular hemorrhage is already accepted treatment. We assessed the efficacy of intravitreal injection of SF6 gas with tPA for submacular hemorrhage caused by age-related macular degeneration (AMD).
The medical records of 33 eyes of 32 patients that underwent pneumatic displacement for submacular hemorrhage associated with AMD were reviewed retrospectively. Submacular hemorrhage was related to classic AMD in 9 eyes and ruptured polypoidal choroidal vasculopathy (PCV) in 24 eyes, and treated with intravitreal injection of SF6 gas with tPA. Flattening of retinal pigment epithelial detachment (PED), postoperative best-corrected visual acuity (BCVA) and the duration until the first additional treatment if needed, and the numbers of required additional treatment were assessed. Improvement and deterioration of BCVA were defined as a change of 0.3 or more in logarithm of minimal angle of resolution (logMAR) visual acuity (VA) compared with the preoperative value.
Mean follow-up period was 35.4±19.8month. Of 24 eyes with PCV, the postoperative VA improved in 9 eyes, stabilized in 14 eyes, and deteriorated in one eye. Of 9 eyes with classic AMD, the postoperative VA improved in 2 eyes, stabilized in 3 eyes, and deteriorated in 4 eyes. Mean BCVA in eyes with PCV significantly improved from 0.62 ± 0.46 to 0.32 ± 0.36 (p=0.01), while eyes with typical AMD did not exhibit significant improvement of mean BCVA. Of 31 eyes that had PED preoperatively, PED flattened in 15 eyes (one eye of classic AMD and 14 eyes of PCV), and number of required additional treatment was 0.9. PED did not change in 16 eyes (6 eyes of classic AMD and 10 eyes of PCV), and required more additional treatment (mean number of 7.0, p<0.01).
For the submacular hemorrhage associated with AMD, intravitreal injection of SF6 gas and tPA was effective, especially for eyes with PCV. PED flattened postoperatively in half cases of PCV and required less additional treatment.
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