Office-based t-PA assisted pneumatic displacement of submacular hemorrhage secondary to neovascular age-related macular degeneration (ARMD): A comparative study of newly-converted, treatment-naïve eyes vs. eyes with anti-VEGF therapy prior to presentation.

Abstract

Purpose : To study the visual outcomes of anti-VEGF-naïve and anti-VEGF-experienced eyes presenting with a submacular hemorrhage secondary to neovascular ARMD who are treated with pneumatic displacement and intravitreal tissue plasminogen activator (t-PA) followed by ongoing anti-VEGF therapy.

Methods : A retrospective chart review was performed for patients who presented from May 2012 to June 2015 with submacular hemorrhage at a multi-physician retina-only group practice. Inclusion criteria were baseline visual acuity (Va) of at least hand-motions vision with at least one year follow-up. All patients received intravitreal t-PA (50 μg /0.1cc) with intravitreal C₃F₈ or SF₆ gas within 48 hours of presentation and received ongoing anti-VEGF injections. Statistical analysis was performed using the binomial test and 2-tailed paired t-test.

Results : 28 eyes of 28 patients were initially identified, and 18 eyes of 18 patients fit the inclusion criteria. 16 eyes had a hemorrhage larger than 6 disc areas in size. Two groups were identified: Group A was naïve to anti-VEGF prior to presentation (n=9, age = 84.3 years, 4 females), and Group B received anti-VEGF prior to presentation (n=9, age = 84.6 years, 6 females). There were no statistical difference for age (p=0.88) or for gender (p=0.37) between both groups.

Overall, the entire cohort began with a logMAR Va of 1.682 (≈20/1000) and improved to 1.064 (≈20/250) after 12 months (p<0.0001). Over two-thirds of patients began with Va worse than legal blindness (20/400), and one third of patients had a final Va better than 20/70. The final average Va of both Group A and B was not statistically different (1.222 vs. 0.971, p=0.308), nor was the magnitude of improvement statistically different (p=0.104).

Conclusions : Office based pneumatic displacement with intravitreal t-PA, followed by regular anti-VEGF therapy is an effective treatment for submacular hemorrhage secondary to neovascular ARMD. These patients benefit from this treatment, regardless of whether they have received prior anti-VEGF therapy. This type of displacement procedure likely reduces the size of the subjective central scotoma and maintains the integrity of the vitreous body for future anti-VEGF therapy.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.