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Benyamin Y. Ebrahim, Laxmi Devisetty, Michael M. Lai; Treatment of Sub-macular Hemorrhage in Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1674.
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To evaluate the efficacy of intra-vitreal injection of anti-VEGF, pneumatic displacement with intravitreal tissue plasminogen activator (tPA), and pars plana vitrectomy (PPV) with intravitreal tPA in the treatment of sub-macular hemorrhage (SMH) in Age-related Macular Degeneration(AMD).
Retrospective Chart Review. Charts were reviewed for SMH detectable clinically by indirect ophthalmoscopy examination of at least 1 disc diameter (DD), documented and followed by IVFA. Patients were treated in a nonrandomized fashion with PPV/tPA (intra-vitreal-50µg), pneumatic displacement/tPA (intra-vitreal 50µg) or intra-vitreal anti-VEGF injection. The study was divided into 3 groups based on the treatment received. Outcome measures: final visual acuity, displacement of the hemorrhage, best visual acuity, and complications. Inclusion criteria: age of 18 or older, diagnosis of AMD associated with SMH, treatment with any the above modalities, follow-up of 6mos or greater. Exclusion criteria: SMH unrelated to AMD and follow up less than 6 months
Total of 32 eyes of 22 patients met the inclusion and exclusion criteria with mean follow up of 22.6 months. In PPV/ tPA group, fifty percent of patients (4/8) had improved visual outcomes, 12.5% of patients retained the same vision, and 37.5% patients had worsening of their visual acuities. In the pneumatic displacement with tPA group, 28.5% of patients had improvement in their visual acuity, 28.5% had no change in vision, while 43% experienced worsening in their visual outcomes. In the intra-vitreal injection of Anti-VEGF, 30% of patients improved, 40% were unchanged, and 30% had worsening in their final visual outcomes. There is no statistically significant difference in visual outcomes among the pneumatic displacement with tPA, PPV with tPA, or intra-vitreal injection of Anti-VEGF.
The prognosis of sub-macular hemorrhage in AMD is very poor, independent of the treatment approach.There is no statistically significant difference in visual outcomes among the pneumatic displacement with tPA, PPV with tPA, or intra-vitreal injection of Anti-VEGF. Even though PPV appears to be more effective at displacing the sub-macular hemorrhage with improvement in visual acuity, the visual improvement was not statistically or clinically significant.
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