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S.B. Weinfurter, A.J. Augustin; Application of Recombinant Tissue Plasminogen Activator (rtPA) and Gas (SF6) in Cases of Submacular Hemorrhage Due to Age-related Macular Degeneration (AMD) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4987.
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Purpose: Age-related macular degeneration (AMD) is the most frequent cause of blindness in the western countries among the elderly. This study investigates the role of the treatment of choroidal neovascularization (CNV) associated submacular hemorrhage by intravitreal injection of rtPA and SF6 in identifying the lesion-composition. Methods: Fluoresceinangiography was performed in patients suffering from submacular bleeding due to exsudative AMD following intravitreal injection of rtPA and SF6 (n=60). The patients were divided into three groups: group I (exclusively/predominantly classic CNV), group II (predominantly/exclusively occult-late leakage type-CNV), group III (pigment epithelium detachment/retinal scar). Results: In 34 of 60 cases (57%) the underlying CNV was exclusively (14 patients) or predominantly classic (20 patients). Photodynamic therapy (PDT) with Verteporfin (VisudyneTM) could be performed here. In 40 cases (78%), more than one week passed between the hemorrhage and the surgical intervention. Nevertheless, 28 patients (70%) observed an improvement or a stabilization of their visual function, while the results among 11 patients treated within one week after the hemorrhage were not significantly better (8 cases of visual improvement or stabilization = 73%). In this small group of patients, the structure of the underlying lesion has no significant influence on the change of visual function: the prognosis is equal for all three groups (median of each group = 0 points of change in visual function) and therefore promises visual stabilization. The only significant correlation can be found between age and visual improvement (wilcoxon-test: p = 0,042). Finally, 25 patients (42%) showed a mean visual improvement of 3 points on the visual scale, 19 patients (32%) observed no change, and 16 patients (27%) noted a mean decrease of - 3,5 points of their visual function. Conclusion: The treatment with intravitreal injection of rtPA and SF6 allows the diagnosis of the underlying retinal lesion; it can reduce the toxic effects of the blood clot and delay the loss of visual function even if performed later than 7 days after hemorrhage. The major part (57%) of patients suffering from subretinal hemorrhage due to AMD show classic CNV and can be treated by means of PDT.
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