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Woohyok Chang, Chanho Cho, Dong Hyoun Noh, Min Sagong; Subretinal Versus Intravitreal Injection Of Recombinant Tissue Plasminogen Activator For Submacular Hemorrhage With Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):866.
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To compare the efficacy of pars plana vitrectomy (PPV) with subretinal injection of recombinant tissue plasminogen activator (rtPA) and gas versus intravitreal rtPA and gas injection without PPV for submacular hemorrhage in age-related macular degeneration (AMD).
We conducted nonrandomized, retrospective, interventional, comparative consecutive series including 37 patients with submacular hemorrhage in AMD. Sixteen patients were treated with PPV, subretinal injections of rtPA and 20% SF6 gas (Group A), 21 patients were treated with intravitreal injections of rtPA and 0.3cc of 100% C3F8 gas (Group B). The main outcome measure was the degree of displacement of submacular hemorrhage from the fovea.
There was no significant difference in mean age, mean hemorrhage size and mean baseline visual acuity between the groups. The mean duration of hemorrhage was longer in Group A than in Group B. (20.44±21.13, 8.52±6.03 days respectively, p=0.006) Complete displacement of submacular hemorrhage was achieved in more patients in Group A (75%) than in Group B (57.1%) without statistical difference.(p=0.370) In both Group A and B, there was statistically significant improvement in mean best-corrected visual acuity (BCVA) from baseline visual acuity. (from 1.57±0.82 to 1.04±0.81 logMAR, from 1.49±0.53 to 0.68±0.72 logMAR respectively, p=0.031, p<0.001, paired t-test) The mean postoperative BCVA change from baseline showed no statistically significant difference between the two groups (p=0.147, Mann-Whitney test). Retinal detachment was developed in two cases, (one case in each group) and a case of vitreous hemorrhage was occurred in Group B as postoperative complications.
Submacular hemorrhage in AMD was effectively displaced pneumatically either by PPV with subretinal injection of rtPA or by intravitreal rtPA without PPV. The two procedures seem to be similarly effective options for the management of submacular hemorrhage in AMD.
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