June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Subretinal hemorrhage due to wet AMD – Combining intravitreal Bevacizumab, recombinant tissue plasminogen activator (RTPA) and gas tamponade for better long-term outcome
Author Affiliations & Notes
  • Johanna Maaß
    Ophthalmology, Universitätklinikum Carl Gustav-Carus, Dresden, Germany
  • Egbert Matthé
    Ophthalmology, Universitätklinikum Carl Gustav-Carus, Dresden, Germany
  • Footnotes
    Commercial Relationships   Johanna Maaß, None; Egbert Matthé, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 910. doi:
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      Johanna Maaß, Egbert Matthé; Subretinal hemorrhage due to wet AMD – Combining intravitreal Bevacizumab, recombinant tissue plasminogen activator (RTPA) and gas tamponade for better long-term outcome
      . Invest. Ophthalmol. Vis. Sci. 2017;58(8):910.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the elderly in industrialized nations. Submacular hemorrhage is a devastating complication of neovascular AMD that cannot be effectively managed with anti-vascular endothelial growth factor (VEGF) injections alone.
Intravitreal recombinant tissue plasminogen activator (RTPA), together with an intravitreal gas tamponade and gravity to move the hemorrhage out of macular region is state of the art.
Aim of this investigation was to report long-term outcomes of the use of an additional, primary intravitreal Bevacizumab (Avastin®) in subjects with submacular hemorrhage.

Methods : Retrospective evaluation of patient charts between 02/2007 and 01/2014 treated with either RTPA and Gas (02/2007-02/2010, “dual combination”, n=31, 16 male, mean age 80,2 years) or Bevacizumab, RTPA and Gas (b/o availability of Bevacizumab, 02/2010-01/2014, “triple combination”, n=43, 16 male, mean age 78,3 years) intravitreally due to submacular hemorrhage. Primary endpoint was best-corrected visual acuity (BCVA; calculations done and data given are in logMAR). Statistics were calculated using SPSS. Student’s t-test (paired, double sided, heteroskedastic) with p<0.05 was used to reflect significance.

Results : During the first 4 weeks there was a significant gain in BCVA, but no difference between both groups (pre: “dual combination” 1.28; “triple combination” 1.27; post: “dual” and “triple combination” 1.02).
Results of the 3 month follow-up showed a further increase in BCVA for patients with “triple combination” (0.75). Patients with the “dual combination” did not show further increase in BCVA after 1 and 3 month (1.02).

Conclusions : During the first month both treatments showed comparable gain in BCVA. After 3 month an ongoing increase of BCVA can only be seen in patients having received the triple combination whereas patients with the dual combination have had no further improvement.
According to this study, treatment of submacular hemorrhage should include Bevacizumab as early as possible, together with established RTPA and gas tamponade.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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