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R. M. Feist, R. S. Vail, COT, M. L. Thomley, M. A. Albert, Jr., T. O. Persaud; Submacular Tissue Plasminogen Activator With Gas Tamponade for Submacular Hemorrhage in Wet Macular Degeneration With or Without Adjunctive Treatment of Intravitreal Bevacizumab (Avastin). Invest. Ophthalmol. Vis. Sci. 2007;48(13):4551.
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To compare the outcomes of eyes having 25-gauge pars plana vitrectomy (PPV) with submacular tissue plasminogen activator (tPA) and gas tamponade for submacular hemorrhage (SMH) in wet macular degeneration (WAMD) with or without adjunctive treatment(s) of intravitreal bevacizumab (Avastin) (IVA).
Retrospective review of two groups of eyes that underwent 25-gauge PPV with submacular tPA and gas tamponade in an effort to displace SMH. Group A consisted of nine eyes that received adjunctive IVA in an effort to inhibit choroidal neovascular membrane (CNVM) development, either during surgery or within two months after surgery, and every two months thereafter or until stability could be appreciated by clinical exam, vision stability and optical coherence tomography (OCT). Group B consisted of 18 eyes underwent the same procedure, but received no adjunctive IVA.
Group A underwent surgery between September 2005 and August 2006. After a mean follow-up of 5.4 months, the average visual improvement was 10.8 lines. Eight of the nine eyes gained three or more lines of vision, and no patients lost lines. Only one patient had less than eight lines of improvement. Five eyes improved from 20/200 or worse to 20/70 or better. There were no other interventional treatments or known complications, with the exception of one eye that experienced a new SMH seven months after the initial procedure. The procedure was repeated with IVA and re-treated with IVA subsequently every two months. Group B all had surgery between June 2001 and September 2005. After a mean follow-up of 10.2 months, the average vision improved 2.61 lines. Ten patients gained three or more lines of vision, while three patients lost three or more lines. Five patients improved from 20/200 or worse to 20/70 or better. Procedures following the initial procedure included subsequent photodynamic therapies (15), intravitreal triamcinolone injections (9), retinal detachment repairs (2), transpupillary thermotherapy (1), and intravitreal pegaptanib (1).
While we know this is a small sample size, we fee that IVA adjunctive therapy to PPV with submacular tPA and gas tamponade can improve the prognosis for SMH attributable to WAMD if followed closely and re-treated regularly with IVA as dictated by clinical appearance, OCT, and vision.
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