Purchase this article with an account.
Isabella D'Agostino, Sara Bochicchio, Matteo Giuseppe Cereda, Giovanni Staurenghi; Intravitreal RTPA injection for macular hemorrhage: long term follow up.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1934.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate long term visual outcome and progression of exudative age related macular degeneration (wet-AMD) in terms of choroidal neovascularization (CNV) activity and OCT B-Scan changes in patients treated with intravitreal injection of recombinant tissue plasminogen activator (rTPA) for recent onset of submacular hemorrhage.
This is a retrospective case series of 25 patients diagnosed with submacular hemorrhage associated with CNV and treated by intravitreal rTPA (50 mg in 0.1 ml) and gas (0.3 cc SF6 99%).The procedure was performed within 14 days from bleeding in all the patients. An anti-VEGF drug was injected in each eye at the day of diagnosis and preceded the pneumatic displacement from 1 to 5 days. Each eye was scanned with SD-OCT(HRA Spectralis, Heidelberg Engineering) at baseline, one day, one week and one month after the main procedure; a pro re nata (PRN) approach was used thereafter. We evaluated visual acuity (VA) before and after procedure, CNV reactivation based on number of anti-VEGF intravitreal injections necessary in the following years.
At baseline the mean VA was 1.3/10 (SD ±0.11) and rise to 2.1/10 (SD ±0.19) at first evaluation after the injection. Ten patients didn't require further treatments because of CNV contraction and poor residual VA (mean 0.03,SD ±0.02), a complete blood dislocation was obtained just in 3 of them. Eleven patients showed a VA improvement from 1.7/10 (DV ±0.10) to 3.5/10 (DV ±0.16) associated with a complete (7/11) o partial (4/11) dislocation of the hemorrhage from macula within 7 days. In eight of them further anti-VEGF intravitreal injections were necessary during the follow up (mean number of injections was 5.5 in the first year,2.7 per year during follow up), while in 3 patients CNV didn’t show other signs of activity. We lost 4 patients at follow up visits. Mean follow up time was 19,8 months (max 39,min 4). In one case vitreous hemorrhage complicated the main procedure.
In our series, best VA outcome correlated with a complete dislocation of the submacular hemorrhage within 7 days. When procedure failed a fibrotic contraction of the CNV occurred and VA outcome was poor. After a complete dislocation of the blood CNV can reactivate. Rate of reactivation is higher during the first year and tends to reduce thereafter.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only