Abstract
Purpose :
Comparison of the current medical and surgical treatment strategies for AMD-related submacular haemorrhage and discussion of use of robotic technology in subretinal drug delivery
Methods :
We retrospectively analysed patients with AMD-related submacular haemorrhage from one tertiary referral centre, the JR Hospital, Oxford. Patients were divided into three main groups according to treatments received: (1) the anti-VEGF monotherapy group; (2) the vitrectomy, subretinal tissue plasminogen activator (TPA) injected manually or with robotic-assistance, air/gas, anti-VEGF group, or (3) intravitreal TPA, gas, anti-VEGF group. We also evaluated long-term outcomes following robot-assisted subretinal TPA injection. Patients were additionally grouped based on haemorrhage size. We then analysed OCT images and BCVA measurements at several timepoints of a 12-month period to compare structural and functional outcomes of each method. Statistical analysis using linear mixed effects model was applied
Results :
The study analysed 44 patients with submacular haemorrhage (≧1DD greatest linear dimension, ≧125mm thick at fovea). 2 eyes opted for no treatment, 7 eyes received anti-VEGF monotherapy and 35 surgery: 24 with subretinal TPA (6 robot-assisted) and 11 with intravitreal TPA injections. At 12 months, haemorrhage resolved in 86% cases following anti-VEGF monotherapy and 84% after subretinal TPA injection (83% robot-assisted, 84% manual); only 45% of cases resolved with intravitreal TPA. Significant haemorrhage area reduction difference was noted after subretinal vs intravitreal TPA (p=0.012). At 12 months, mean BCVA improvement for all treated eyes was 0.22logMAR (>10 ETDRS letters) vs baseline (p=0.22), with no significant differences between treatment groups (p>0.05). BCVA improvement >10 ETDRS letter was observed in 17 patients: 1 anti-VEGF monotherapy, 11 subretinal TPA (1 robot-assisted, 10 manual) and 5 intravitreal TPA
Conclusions :
No consensus on optimal treatment strategy for AMD-related submacular haemorrhage exists. While anti-VEGF monotherapy and subretinal TPA injection were better at inducing haemorrhage resolution than intravitreal TPA injection, no significant difference in BCVA change occurred between surgical approaches vs anti-VEGF monotherapy. Robot-assisted subretinal TPA delivery was feasible and safe, and its future optimisations may offer opportunities to improve submacular haemorrhage management and outcomes
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.