June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Pars plana vitrectomy with subretinal tissue plasminogen activator, bevacizumab, air injection and intraocular gas tamponade for submacular hemorrhage secondary to age-related macular degeneration.
Author Affiliations & Notes
  • Jihoon Jeon
    Seoul National University, Seoul, Korea (the Republic of)
  • Jang Won Heo
    Seoul National University, Seoul, Korea (the Republic of)
  • Hum Chung
    Seoul National University, Seoul, Korea (the Republic of)
  • Young Suk Yu
    Seoul National University, Seoul, Korea (the Republic of)
  • Footnotes
    Commercial Relationships   Jihoon Jeon, None; Jang Won Heo, None; Hum Chung, None; Young Suk Yu, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2829. doi:
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      Jihoon Jeon, Jang Won Heo, Hum Chung, Young Suk Yu; Pars plana vitrectomy with subretinal tissue plasminogen activator, bevacizumab, air injection and intraocular gas tamponade for submacular hemorrhage secondary to age-related macular degeneration.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2829.

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

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Abstract

Purpose : To evaluate the efficacy and safety of pars plana vitrectomy(PPV), subretinal tissue plasminogen activator(t-PA), bevacizumab, air injection and intraocular gas(Sulfer hexafluoride,SF6) tamponade for age-related macular degeneration (AMD) with submacular hemorrhage (SMH).

Methods : 23 eyes with AMD and SMH who received PPV, subretinal t-PA(12.5μg/0.1mL), bevacizumab(2.5mg/0.1mL), air injection and intraocular gas(SF6 10%) tamponade were enrolled. Main outcome measures included degree of blood displacement, preoperative and postoperative best corrected visual acuity (BCVA), and adverse events. Additionally, the height of SMH, central retinal thickness(CRT), pigment epithelial detachment(PED) and ellipsoid layer documented with optical coherence tomography(OCT) was measured.

Results : The SMH of the 23 eyes, 8 medium, 13 large, 2 massive, and mean size was 30.0 disc area. Complete displacement of SMH was achieved in 13 of 23 eyes(56.5%). Postoperative 3months, there was visual improvement in 10eyes(43.5%), no visual improvement in 4 eyes(17.4%), and poorer vision in 9eyes(39.1%). The BCVA was significantly better in eyes(n=12) with preoperative detectable ellipsoid layers(P=0.01). At base line, the mean height of the SMH was 690.39±411.73mm, CRT was 968.57±682.64mm, and PED was 639.43±709.16mm. Postoperative 3month, those were decreased to 95.18±446.44mm(p=0.001), 442.34±448.99 mm(p=0.001), 239.34±330.38 mm(p=0.002) And, eyes with preoperative lower height of SMH,CRT,PED exhibited more successful blood displacement (P<0.05) but, not correlate with postoperative BCVA. Postoperative complications included vitreous hemorrhage(VH) in 6 eyes, recurrent SMH in 1 eye, rhegmatogenous retinal detachment(RRD) in 1 eye, atrophic scar in 3 eyes, macular hole 1 eye and retinal pigment epithelium tear 1 eye. Additionaly, 6 eyes that had subretinal fluid postoperatively, received more intravitreal anti-VEGF treatments.

Conclusions : PPV with subretinal t-PA,bevacizumab, air injection and gas tamponade was found to be relatively effective for displacement of SMH with improvement in visual acuity. And also, the preoperative OCT findings may be useful for prediction of blood displacement and visual acuity. However, postoperative complications should be examined and managed properly for better visual prognosis.

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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