Abstract
Purpose :
To compare the visual outcome between intravitreal gas with tissue plasminogen activator (t-PA) injection and intravitreal anti-vascular endothelial growth factor (VEGF) injection as an initial treatment for submacular hemorrhage (SMH) associated with ager related macular degeneration (ARMD).
Methods :
We reviewed the medical records of the naïve patients who treated with intravitreal gas injection with t-PA (group 1) and intravitreal anti-VEGF injection (group 2) as an initial treatment for SMH (≥ 2 disc diameter, DD) associated with ARMD from 2 institutions. Both group received 3 monthly loading anti-VEGF injections and was followed by as-needed injection for the ARMD treatment. The change of best corrected visual acuities (BCVA, logMAR) between at initial visit and at 6 months was compared were compared between 2 groups.
Results :
82 patients were enrolled, 32 patients (group 1) were initially treated with intravitreal gas with t-PA injections and 50 patients (group 2) were treated with anti-VEGF injections. The mean logMAR BCVA at 6 months after initial treatments was not significantly different, 0.76 (±0.83) in group 1 and 0.84 (±0.79) in group 2 (p=0.683). However, the mean change of BCVA between at initial visit and at 6 months was -0.52 (±0.88) in group 1, which was significantly greater than -0.15 (±0.58) in group 2 (p=0.044). In cases with SMH size ≥ 5 DD, mean BCVA changes were -0.49 (±0.97) , -0.11 (±0.62) in group 1 and 2, respectively, but not statistically different (p=0.60). But, in cases with ≥ 7DD and ≥10DD, mean BCVA changes were -0.50 (±0.99), -0.67 (±0.73) in group 1 and statistically larger than -0.06 (±0.64), 0.03 (±0.66) in group 2. (p=0.038, 0.007) (Fig.1)
Conclusions :
Intravitreal gas with t-PA injection as an initial treatment for SMH showed greater visual change from initial state than anti-VEGF injection. Especially in larger SMH cases, the effect of the gas with t-PA treatment on the visual improvement was more prominent and the anti-VEGF monotherapy showed very little effect.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.