June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Office-based t-PA assisted pneumatic displacement of submacular hemorrhage secondary to neovascular age-related macular degeneration (ARMD): A comparative study of newly-converted, treatment-naïve eyes vs. eyes with anti-VEGF therapy prior to presentation.
Author Affiliations & Notes
  • Santosh P Bhaskarabhatla
    Department of Ophthalmology, Robert Wood Johnson Medical School, Rutgers University, Woodland Park, New Jersey, United States
  • Howard F Fine
    Department of Ophthalmology, Robert Wood Johnson Medical School, Rutgers University, Woodland Park, New Jersey, United States
    NJ Retina, New Brunswick, New Jersey, United States
  • Dimosthenis Mantopoulos
    Department of Ophthalmology, Robert Wood Johnson Medical School, Rutgers University, Woodland Park, New Jersey, United States
  • Daniel B. Roth
    Department of Ophthalmology, Robert Wood Johnson Medical School, Rutgers University, Woodland Park, New Jersey, United States
    NJ Retina, New Brunswick, New Jersey, United States
  • Nicholas Chinskey
    Department of Ophthalmology, Robert Wood Johnson Medical School, Rutgers University, Woodland Park, New Jersey, United States
    NJ Retina, New Brunswick, New Jersey, United States
  • Sumit P. Shah
    Department of Ophthalmology, Robert Wood Johnson Medical School, Rutgers University, Woodland Park, New Jersey, United States
    NJ Retina, New Brunswick, New Jersey, United States
  • Footnotes
    Commercial Relationships   Santosh Bhaskarabhatla, None; Howard Fine, Alimera Sciences (F), Alimera Sciences (C), Alimera Sciences (R), Allergan (F), Allergan (C), Allergan (R), Auris Surgical Robots (I), Auris Surgical Robots (P), Auris Surgical Robots (C), Auris Surgical Robots (R), Genentech (F), Genentech (C), Genentech (R), Regeneron (F), Regeneron (C), Regeneron (R); Dimosthenis Mantopoulos, None; Daniel Roth, Alimera Sciences (F), Alimera Sciences (C), Alimera Sciences (R), Allergan (F), Allergan (C), Foresight Labs V4 (I), Foresight Labs V4 (C), Genentech (F), Ohr Pharmaceuticals (I), Ohr Pharmaceuticals (C), Regeneron (F), Regeneron (C); Nicholas Chinskey, None; Sumit Shah, Alimera Sciences (F), Alimera Sciences (C), Alimera Sciences (R), Allergan (F), Allergan (C), Allergan (R), Genentech (F), Genentech (C), Genentech (R), Regeneron (F), Regeneron (C), Regeneron (R)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1928. doi:
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      Santosh P Bhaskarabhatla, Howard F Fine, Dimosthenis Mantopoulos, Daniel B. Roth, Nicholas Chinskey, Sumit P. Shah; Office-based t-PA assisted pneumatic displacement of submacular hemorrhage secondary to neovascular age-related macular degeneration (ARMD): A comparative study of newly-converted, treatment-naïve eyes vs. eyes with anti-VEGF therapy prior to presentation.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1928.

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

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Abstract

Purpose : To study the visual outcomes of anti-VEGF-naïve and anti-VEGF-experienced eyes presenting with a submacular hemorrhage secondary to neovascular ARMD who are treated with pneumatic displacement and intravitreal tissue plasminogen activator (t-PA) followed by ongoing anti-VEGF therapy.

Methods : A retrospective chart review was performed for patients who presented from May 2012 to June 2015 with submacular hemorrhage at a multi-physician retina-only group practice. Inclusion criteria were baseline visual acuity (Va) of at least hand-motions vision with at least one year follow-up. All patients received intravitreal t-PA (50 μg /0.1cc) with intravitreal C3F8 or SF6 gas within 48 hours of presentation and received ongoing anti-VEGF injections. Statistical analysis was performed using the binomial test and 2-tailed paired t-test.

Results : 28 eyes of 28 patients were initially identified, and 18 eyes of 18 patients fit the inclusion criteria. 16 eyes had a hemorrhage larger than 6 disc areas in size. Two groups were identified: Group A was naïve to anti-VEGF prior to presentation (n=9, age = 84.3 years, 4 females), and Group B received anti-VEGF prior to presentation (n=9, age = 84.6 years, 6 females). There were no statistical difference for age (p=0.88) or for gender (p=0.37) between both groups.

Overall, the entire cohort began with a logMAR Va of 1.682 (≈20/1000) and improved to 1.064 (≈20/250) after 12 months (p<0.0001). Over two-thirds of patients began with Va worse than legal blindness (20/400), and one third of patients had a final Va better than 20/70. The final average Va of both Group A and B was not statistically different (1.222 vs. 0.971, p=0.308), nor was the magnitude of improvement statistically different (p=0.104).

Conclusions : Office based pneumatic displacement with intravitreal t-PA, followed by regular anti-VEGF therapy is an effective treatment for submacular hemorrhage secondary to neovascular ARMD. These patients benefit from this treatment, regardless of whether they have received prior anti-VEGF therapy. This type of displacement procedure likely reduces the size of the subjective central scotoma and maintains the integrity of the vitreous body for future anti-VEGF therapy.

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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