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L. V. Atkuru, H. Kim, M. M. Lai; Outcomes of Surgical vs. Medical Management of Submacular Hemorrhage in AMD patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):259.
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To evaluate the outcomes of intravitreal Avastin vs. pars plana vitrectomy with tissue plasminogen activator (PPV/tPA) in the treatment of submacular hemorrhage (SMH) associated with age-related macular degeneration (ARMD).
A retrospective, comparative study of consecutive patients with SMH treated non-randomly with PPV/tPA or Avastin at a single retina practice. Inclusion criteria are age > 18y, presence of SMH over 2.5 mm in size involving the fovea, history of ARMD, and treatment with Avastin or PPV/tPA. Patients with follow-up period < 6 months, or SMH secondary to non-ARMD causes are excluded from the study. The outcomes studied include visual acuity, anatomic resolution of hemorrhage, and complications.
12 patients treated with PPV/tPA (group 1) and 7 patients treated with Avastin (group 2) were evaluated in the study. The mean age was 81 yrs in group 1 and 83 yrs. in group 2 (p = 0.47). The baseline mean visual acuity was 20/400 for group 1 and 20/200 for group 2 (p = 0.88). The final visual acuity was 20/400 (p = 0.32) for both groups. In group 1, 42% of patients improved, 42% lost vision, and 16% stabilized. In group 2, no patient gained vision, 33% lost vision and 67% stabilized. Complications noted in group 1 included increased submacular hemorrhage with re-bleed, disciform scar, and epiretinal membrane with PED. Complications noted in group 2 included persistent submacular heme and sub-retinal fluid.
There was no statistical significance in the mean final visual acuity (p = 0.32) between the two groups. However, there was a trend to improvement in visual acuity at last follow-up in group 1 (p = 0.09). In addition, patients treated with PPV/tPA were more likely to gain vision than patients treated with Avastin.
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