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Mathias M. Maier, Caroline Perz, Julia Konrad, Nikolaus Feucht, Christoph Winkler von Mohrenfels, Chris P Lohmann; Treatment of SRH in AMD with Combined 23-gauge Core Vitrectomy and Injection Of RTPA, Expansile Gas and Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2011;52(14):118.
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To evaluate the long term efficacy of 23-gauge sutureless core vitrectomy with consecutive intravitreal injection of recombined tissue plasminogen activator (rtPA), expansile gas and bevacizumab for the treatment of subretinal hemorrhage (SRH) in patients with exudative age related macular degeneration (AMD).
We evaluated retrospectively the data of 47 eyes of 47 patients (33 women, 14 men, mean age 84) with SRH secondary to AMD who were treated with 23-gauge core vitrectomy followed by an injection of 0.05 ml rtPA (50 µg), 0.3 ml of sulphur hexafluoride (SF6) gas and 0.05 ml bevacizumab (1.25 mg). Visual acuity (VA), retinal thickness as determined by optical coherence tomography and frequency of anti-VEGF therapy were evaluated pretreatment as well as over a one year follow-up period.
The median VA pretreatment was 1.3 logMAR, remained stable at 1 month and 3 month postoperatively and improved to 1.1 logMAR at 6 months and at 8 months postoperatively. The central foveal thickness decreased by 44 µm at month 1, by 51 µm at month 3 and by 88 µm at month 6 postoperatively.After effective displacement of the SRH, fluorescein angiography revealed in 79 % of patients (37/47) still active choroidal neovascularisation which was treated with further anti-VEGF therapy.
The combined application of rtPA, gas and bevacizumab via 23-gauge core vitrectomy for the treatment of SRH secondary to exudative AMD appears to be a safe and effective method with a gain in VA and anatomic improvement. The addition of an anti-VEGF agent seems important to limit the progression of the underlying disease. Randomized long-term studies are recommended.
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