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Sarina Amin, Yael Kusne, David Goldenberg, Derek Y Kunimoto, Karim Jamal; Improved visual prognosis with early vitrectomy and subretinal tissue plasminogen activator injection in patients with submacular hemorrhage due to neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2398.
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© ARVO (1962-2015); The Authors (2016-present)
To compare visual outcomes of early versus delayed pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (tPA) injection, and fluid-gas exchange for submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (nvAMD).
This retrospective study included 52 eyes from 2009-2015 with acute SMH due to nvAMD. All patients underwent PPV, subretinal tPA injection, and fluid-gas exchange. Duration of SMH, follow-up interval, preoperative visual acuity (VA), best postoperative VA, final VA at last follow-up exam, and postoperative complications were recorded for each patient. Duration of SMH was defined as the time from symptom onset to surgery. Patients were divided into three groups based on duration of SMH; group A: less than 7 days (n=28), group B: 8-14 days (n=13), and group C: greater than 14 days (n=11).
The mean duration of SMH was 4.6 days in group A, 10.8 days in group B, and 19.5 days in group C. The average length of follow-up for all patients was 16 months. The mean preoperative VA for groups A, B, and C was 1.63, 1.49, and 1.83 logMAR, respectively. The mean best postoperative VA was 0.96, 1.10, and 1.51, respectively, and the mean final VA was 1.28, 1.38, and 1.65, respectively. The difference between preoperative and postoperative best VA was statistically significant for groups A and B (p<0.001 and p=0.036) but was not significant for group C (p=0.14). The difference between preoperative and final VA was significant for group A (p=0.008) but was not significant for groups B and C (p=0.23 and p=0.35). Vision improved by at least 1 line for 79% of patients in group A, 62% in group B, and 36% in group C (p=0.04). Vision improved by at least 3 lines for 36% in group A, 31% in group B, and 18% in group C (p=0.644). Three patients developed recurrent SMH after failing to return for follow up care.
Patients with acute SMH due to nvAMD may benefit from early PPV, subretinal tPA injection, and fluid-gas exchange. Surgery within the first 7 days after symptom onset is optimal and may improve long-term visual prognosis. It is important to continue treatment with intravitreal anti-vascular endothelial growth factor injections postoperatively to reduce the risk of recurrent SMH.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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