July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Sub-retinal tPA injection with pars plana vitrectomy and air-fluid displacement of dense sub-macular hemorrhage
Author Affiliations & Notes
  • Carl S Wilkins
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Neesurg Sunil Mehta
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Chris Wu
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Alexander Barash
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Avnish Deobhakta
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Richard B Rosen
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Footnotes
    Commercial Relationships   Carl Wilkins, None; Neesurg Mehta, None; Chris Wu, None; Alexander Barash, None; Avnish Deobhakta, None; Richard Rosen, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5755. doi:https://doi.org/
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      Carl S Wilkins, Neesurg Sunil Mehta, Chris Wu, Alexander Barash, Avnish Deobhakta, Richard B Rosen; Sub-retinal tPA injection with pars plana vitrectomy and air-fluid displacement of dense sub-macular hemorrhage. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5755. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Fovea-involving sub-retinal hemorrhage is difficult to treat and may have devastating visual outcomes. We sought to investigate the potential benefit of pars plana vitrectomy (PPV) with sub-retinal alteplase (tPA) and intravitreal gas displacement for fovea-involving macular hemorrhage. This study aims to elucidate outcomes and identify patient subgroups who may benefit more from intervention.

Methods : A retrospective case series was performed of all patients who underwent PPV and had an associated pharmacy J-code for intraoperative tPA. Eighty-one patients fit inclusion criteria; 37 patients remained after exclusion. Reasons for exclusion included intravitreal tPA injection in office without surgery, insufficient follow-up, or insufficient documentation in the operative report despite a linked pharmacy code. Mean pre-operative, post-op month 1 and 3, and final visual acuity were measured using Snellen visual acuity. All visual acuities were converted into LogMAR for analysis.

Results : The mean age was 68.2 years, with 54.1% females. The most common underlying etiology was exudative macular degeneration (43.2%), followed by undifferentiated (21.6%), polypoidal choroidal vasculopathy (18.9%), trauma-related choroidal neovascularization (8.1%), macroaneurysm (5.4%), and proliferative diabetic retinopathy (2.7%). Pseudophakic patients comprised 51.4%, phakic 40.5%, and aphakic or undocumented 8.1%. Eight patients (21.6%) were on anticoagulation or antiplatelet therapy. Ten total patients (27%) had complications including 4 vitreous hemorrhages (10.8%), 3 recurrent submacular hemorrhages (8.1%), 3 rhegmatogenous retinal detachments (8.1%), 1 phthisical eye (2.7%), and 1 corneal endothelial failure (2.7%). Mean pre-op visual acuity was 20/1239. Mean visual acuity at post-op month 1, month 3, and at last follow-up were 20/427 (p=0.0082), 20/267 (p=0.0028), and 20/215 (p=0.0005), respectively. Mean central subfield thickness on SD-OCT was 512.2 μm and 648.2 μm for predominantly sub-RPE heme and sub-retinal heme, respectively, and difference in mean visual acuity was not statistically significant by location of hemorrhage (p=0.481).

Conclusions : Sub-retinal tPA injection in combination with pars plana vitrectomy and air-fluid displacement of dense submacular hemorrhage appears to have modest efficacy in visual recovery, though long-term vision may be limited by underlying pathology.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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