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Shulamit Schwartz, Adiel Barak, Anat Loewenstein, Dinah Zur; Predictive Factors for Visual Outcome after Submacular Hemorrhage - A comparative Treatment Study. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1800.
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© ARVO (1962-2015); The Authors (2016-present)
Submacular hemorrhage (SMH) is a potentially devastating condition, associated with poor visual outcome, especially in age related macular degeneration (AMD). We compared the functional and anatomic outcomes of patients treated with pars plana vitrectomy (PPV) versus pneumatic displacement (PD) with intravitreal (IVT) tissue plasminogen activator (tPA).
A retrospective case series of consecutive patients with SMH and symptoms duration of up to 14 days. Patients were divided into two groups according to treatment modality: PPV or IVT tPA and PD using pure gas. AMD patients received supplemental anti VEGF injections. Data collection included visual acuity (VA) and central macular thickness (CMT) upon presentation and 1 to 6 months follow up. SMH size was defined as <2DD, > 2DD, up to or beyond vessel arcades. Main outcome was change in VA and secondary outcomes were change in CMT and complications.
55 patients with mean age of 82.5 ±7.9 years were included. The underlying disease was AMD in 45 patients (82%), 25.5% of them newly diagnosed. 8 patients had macro aneurysm and 2 patient had myopia. 22 underwent PPV and 33 treated with PD and tPA according to physician discretion. Symptoms duration was shorter in the PD group compare to PPV group (5.1±5.2 and 9.8±6.9 days respectively; p=0.001). Mean VA decreased from 1.4 ± 0.5 to 1.1± 0.6 logMAR in the PD group and from 1.8 ± 0.4 to 1.6± 0.6 logMAR in the PPV group (p=0.008). Initial VA was moderately correlated to VA at 6 months (r=0.482 p<0.001). We found a 39.1% reduction in the number of patients with poor initial VA <6/60 in the PD group compared to 21.4% patients in the PPV group.19 (57.6%) patient in the PD group and 18 (81.8%) patients in the PPV group had a large SMH (P=0.06). Subgroup analysis showed that those patients had a better VA at 6 months in the PD group (1.2 ± 0.6 vs 1.5 ± 0.7 log MAR, p=0.04). Neither procedure type nor SMH size were significantly associated with final VA in multivariate regression models. Initial VA was the only significant predictor for VA outcome. Overall, CMT decreased from 930.3 ±860.0 to 417.9±330.0 after 6 months. 2 patients developed retinal detachment, one in each group. Five patients with MA treated with PD developed vitreous hemorrhage.
PD with IVT tPA and PPV comparably improve vision and anatomic outcome in patients with SMH without remarkable complications.
This is a 2020 ARVO Annual Meeting abstract.
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