Abstract
Purpose :
To compare the efficacy of pneumatic displacement with intravitreal recombinant tissue plasminogen activator (rTPA) versus vitrectomy with subretinal injection of rTPA with/without anti-VEGF for SMH.
Methods :
Retrospective analysis of thirty consecutive patients presenting with SMH in two surgical units between 2012-2016. Group 1 received intravitreal pneumatic displacement and intravitreal rTPA with/without intravitreal anti-VEGF. Group 2 received pars plana vitrectomy in combination with subretinal rTPA, with/without subretinal Anti-VEGF, with gas tamponade. Primary outcome measure was SMH displacement. Secondary outcomes included best-corrected visual acuity (BCVA) change post-operatively, SMH height, SMH area, and surgical complications.
Results :
Eleven patients included in Group 1 and 19 in Group 2. Haemorrhagic displacement was complete in 9 (82.8%) out of 11 and 18 (94.7%) out of 19 patients in Groups 1 and 2, demonstrating no difference between them (p=0.536). BCVA improved by -0.50±0.74 (p=0.045) and -0.72±0.93 (p=0.004) compared to baseline at 6 months in Groups 1 and 2, with no difference between groups (p=0.155). Subfoveal haemorrhage height reduced (Group 1:-900.57μm, p=0.007; Group 2:-607.27μm, p<0.001), without difference between groups (p=0.582).
Conclusions :
Intravitreal treatment and vitrectomy were equally effective at subfoveal haemorrhagic displacement. BCVA gains did not differ significantly between techniques. OCT data demonstrated similar efficacy in both techniques. This data supports the use of either intravitreal or vitrectomy treatment as a first line therapy for SMH.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.