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Yuki Morizane, Shuhei Kimura, Mio Hosokawa, Yusuke Shiode, Shinichiro Doi, Masayuki Hirano, Ryo Matoba, Mika Hosogi, Atsushi Fujiwara, Fumio Shiraga; Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy, subretinal tissue plasminogen activator, air tamponade, and anti-VEGF. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2851.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate vitrectomy with subretinal tissue plasminogen activator (t-PA) injection, and air tamponade, followed by intravitreal anti-vascular endothelial growth factor (VEGF) therapy for submacular hemorrhage (SMH) in polypoidal choroidal vasculopathy (PCV).
Fifteen eyes of 15 consecutive patients who underwent vitrectomy with subretinal t-PA injection, and air tamponade, followed by intravitreal anti-VEGF therapy for SMH due to PCV were studied. Patients with SMH due to other macular diseases, such as high myopia, typical AMD, retinal angiomatous proliferation, and angioid streaks, were excluded. To displace the SMH from the macula, 25-gauge micro-incision vitrectomy, subretinal injection of 4,000 IU t-PA (Cliactor, Eizai, Japan) in 0.1ml using a 38-gauge subretinal infusion needle (MedOne, Sarasota, FL), and fluid-air exchange were performed. The patients remained facedown for 3 days after surgery. Intravitreal injections of anti-VEGF reagents of either 0.5 mg ranibizumab (Genentech, Inc., South San Francisco, CA) or 0.5 mg aflibercept (Bayer, Basel, Switzerland) were performed pro re nata when exudative and/or hemorrhagic changes occurred after surgery. Main outcome measures were SMH displacement from the macula and changes in best-corrected visual acuity (BCVAs).
Mean time from onset to surgery was 9.5 ± 4.5 (range, 5-21) days. Mean follow-up period was 9.4 ± 3.1 (range, 6-17) months. Surgery successfully displaced SMHs from the macula in all eyes. Mean BCVA (logMAR) at base line (0.98 ± 0.44) had improved significantly both 1 month after surgery (0.41 ± 0.25, P<0.01) and at final visits (0.23 ± 0.25, P<0.001). In all eyes, exudative retinal changes relapsed after surgery, but were completely resolved by anti-VEGF injections (mean number, 3.5 ± 1.9). No complications occurred in any patients.
Treating SMH with vitrectomy and subretinal t-PA injection, followed by intravitreal anti-VEGF therapy, is a safe and very effective strategy for improving visual acuity in PCV patients.
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