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S. Sacu, E. Stifter, P. Vécsei-Marlovits, S. Michels, C. Schütze, C. Pruente, U. Schmidt-Erfurth; Management of Extensive Subfoveal Haemorrhage With Intravitreous Tissue Plasminogen Activator, Pneumatic Displacement and Anti-Angiogenic Treatment. Invest. Ophthalmol. Vis. Sci. 2008;49(13):580.
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To investigate the efficacy and safety of treating subfoveal hemorrhages secondary to neovascular age-related macular degeneration (AMD) with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) or with an anti-VEGF monotherapy.
In this retrospective clinical case series, 30 eyes of 30 neovascular AMD patients with large subfoveal hemorrhage were evaluated. In group A, patients received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab). Patients who refused intravitreal rTPA/gas injections were treated with an anti-VEGF monotherapy (bevacizumab) alone and included into group B. Retreatments were performed with intravitreal anti-VEGF injections in 4-week intervals based on optical coherence tomography (OCT) findings.Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and hemorrhage size were analyzed. A safety assessment was performed at all visits.
In group A, 20 eyes of 20 patients (mean age: 75.3 ± 8.5 years) and in group B, 10 eyes of 10 patients (mean age: 75.3 ± 8.5 years) were followed for 4 months.The mean period between symptomatic onset of submacular hemorrhage and the time of initial treatment was 7.1 ± 3.8 days in group A and 12.9 ± 12.6 in group B.In group A (rTPA / gas / anti-VEGF), mean baseline VA was 0.15 ± 0.2 (equivalent to logMAR 1.1), ranging from 0.01 to 0.8 (logMAR 0.1 to logMAR 2.0). In group B (anti-VEGF monotherapy), mean baseline VA was 0.25 ± 0.17 (equivalent to logMAR 0.6), ranging from 0.05 to 0.6 (logMAR 1.3 to logMAR 0.2). At month 4, mean VA was significantly improved in group A (mean difference: +0.1±0.14; p=0.003), whereas a stabilization of VA was observed in group B (mean difference: +0.008±0.2; p=0.94). CRT decreased significantly by 70µm in group A (p=0.001) and by 84µm in group B (p=0.03). Mean size of hemorrhage was significantly reduced from 20.2 ± 5.3 mm² at baseline to 0.0mm² at month 4 follow-up in group A and from 19.1mm² to 2.0mm² in group B, respectively (p<0.001). Anti-VEGF treatmentrate was 1.6 in group A, and 3.0 in group B. In one eye, a recurrent vitreous hemorrhage was observed 1 week after rTPA/gas/anti-VEGF.
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