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F. Betis, F. Berthier, P. Gastaud, C. Zur; Intravitreal Drainage of Thick Submacular Hemorrhage by Pars Plana Vitrectomy, Small Retinotomy, Subretinal Injection of Tissue Plasminogen Activator and Gas, in Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4654.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the safety and efficacy of a procedure for surgical drainage of thick submacular hemorrhages (SMHs) in patients with age–related macular degeneration (ARMD)
Seventeen consecutive eyes of 17 patients with SMH secondary to ARMD were treated with vitrectomy, only one small retinotomy, subretinal injection of tissue plasminogen activator (25 µg per 0.1 ml), and partial gas tamponade (0,4 ml of pure C3F8), without postoperative prone positioning. Outcome measures included hematoma size, preoperative, best and final postoperative visual acuity (using an ETDRS chart).
Mean duration of postoperative follow–up was 8.4 months (range, 3–18 months). Complete spontaneous drainage of subretinal hemorrhage into the vitreous cavity was observed within 24 hours, in 16 cases. The size of the successfully–treated SMHs was between 4 and 47 disk area (DA) with an average of 22.5 DA. Mean time to complete intravitreal hemorrhage resorption was 13 days (range, 1–28 days). The hemorrhage size was negatively (R = –0.59; P = 0.013) correlated with the postoperative visual acuity. Best visual acuity improved by 16.4 ETDRS letters in all SMHs (P = 0.002), by 26.4 ETDRS letters in non–massive SMHs (8/17, mean area 11.5 DA) (P = 0.0078), and by 6.5 ETDRS letters in massive SMHs (9/17, mean area 37.6 DA) (P = 0.37; ns).
This technique allow spontaneous intravitreal drainage of thick SMHs and can improve vision in patients with ARMD. Peroperative and postoperative procedures were simple, and have been well tolerated and well observed by aged patients who don't usually support the constraints of postoperative prone positioning
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