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S. P. Shah, J. Hubschman, C. R. Gonzales, S. D. Schwartz; Combination Submacular Anti-VEGF Therapy and Recombinant Tissue Plasminogen Activator for Management of Massive Submacular Hemorrhage in ARMD. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5981.
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To retrospectively evaluate combination submacular anti-VEGF therapy and recombinant tissue plasminogen activator (rt-PA) for management of massive submacular hemorrhage in ARMD.
Two cases were retrospectively reviewed. Patient’s underwent 25-gauge pars plana vitrectomy, surgical induction of posterior vitreous separation, submacular injection of both rt-PA and anti-VEGF therapy, and 20% SF6 intraocular tamponade. Both patient’s received their first postoperative intravitreous anti-VEGF injection 4-6 weeks after surgery. Pre and post operative findings are reviewed.
Patient #1An 84 year-old male with known ARMD presented with sudden, painless vision loss to CF at 4 feet and was diagnosed with a fresh, large submacular hemorrhage. He urgently underwent the procedure described above. The hemorrhage was successfully displaced and the visual acuity at last follow up was 20/70. The patient has continued to undergo regular intravitreous anti-VEGF injections. Findings include minimal persistent subretinal fluid and resolved submacular hemorrhage.Patient #2A 77 year-old female with known ARMD and a pigment epithelial detachment presented with sudden, painless vision loss. Preoperative vision was 20/125-2. She urgently underwent the procedure described above. At POM #9, the visual acuity was 20/70-1 with an extrafoveal tear of the retinal pigment epithelium. She has continued to receive regular intravitreous anti-VEGF injections since her surgery.
Combination submacular anti-VEGF therapy delivered at the time of pars plana vitrectomy and submacular tissue plasminogen activator assisted hemorrhage displacement may be a viable treatment strategy for the management of patients with massive submacular hemorrhage. Prospective evaluation of this strategy may be warranted.
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