Real-time intraoperative SD-OCT monitoring of transretinal rt-PA injection for AMD-related submacular hemorrhage

Abstract

Purpose: To describe a minimally invasive technique for subretinal injection of Recombinant Tissue Plasminogen Activator (rt-PA).

Methods: Patients operated on for thick AMD-related submacular hemorrhage by transconjunctival 25-Gauge vitrectomy, transretinal injection of rt-PA through the 25G cannula with a 41G soft tip needle and fluid-gas exchange. Real-time monitoring of the infusion site to ascertain the absence of any retinal break was obtained by a microscope integrated SD-OCT system Postoperative prone positioning was advised for five days. Main outcome measures included hematoma displacement rate; pre- and postoperative best corrected visual acuity (BCVA) and postoperative complications.

Results: Nineteen patients were included. Mean age was 81,3 (±8.1) years and mean follow-up of 2.7 months. At postoperative month one, total displacement of the submacular hemorrhage was obtained for 11 patients (58%) and none had no displacement. Mean BCVA significantly improved from 2,1 (±0,9) to 1,6 (±0,8) LogMAR units (p=0.005). In all, 12 patients (70%) gained at least two lines of VA and only one patient lost two or more lines. Six patients (31%) had postoperative complications including intraocular bleeding (n=4); severe low IOP and rhegmatogenous retinal detachment.

Conclusions: Transretinal injection to treat AMD-related submacular hemorrhage seemed to be effective with acceptable risks as compared to more invasive procedures.