[Intravitreal injection of rt-PA and gas in the management of minor submacular haemorrhages secondary to age-related macular degeneration].
BACKGROUND
Subfoveal haemorrhage is a serious complication of choroidal neovascularization in age-related macular degeneration (ARMD). Recent studies have demonstrated that intravitreal injections of the fibrinolytic agent recombinant tissue plasminogen activator (rt-PA) and expansile gas may be effective in displacing submacular blood and facilitating visual improvement. However, in most of these studies, this technique has been used for the management of major haemorrhages. The purpose of our study was to investigate the efficacy of treating minor subfoveal haemorrhages with intravitreal rt-PA and pneumatic displacement.


METHODS
In a prospective study, 25 consecutive eyes of 25 patients with recent (</= 28 days) subfoveal haemorrhage secondary to ARMD and severe visual loss were treated with intravitreous injections of rt-PA (50 micro g) and sulfur hexafluoride (0,5 ml). The extent of the haemorrhage ranged from R to 2 disc areas. Patient follow-up ranged between 4 and 18 months.


RESULTS
Best postoperative visual acuity compared with preoperative visual acuity was improved by two or more Snellen lines in 11 of 25 eyes (44 %). Seven eyes (28 %) maintained this level at the final visit. Duration of haemorrhage was associated with a better gain of lines of vision. In a subgroup of 9 eyes with duration of haemorrhage </= 14 days, 7 (78 %) improved by two or more Snellen visual acuity lines, whereas only 4 of 16 eyes (25 %) with duration of haemorrhage > 14 days showed a comparable outcome (p = 0.017). There were no side effects or complications.


CONCLUSIONS
Our findings suggest that intravitreous injections of rt-PA and sulfur hexafluoride are of value for an improved and accelerated visual recovery in ARMD patients with minor subfoveal haemorrhages. Duration of haemorrhage </= 14 is associated with a better gain of lines of vision. Final visual outcome, however, is limited by the underlying ARMD. In addition, a rapid displacement of subfoveal haemorrhages may reveal discrete choroidal neovascular membranes amenable to further treatment. The complication rate of this therapeutic approach appears to be low.
Klinik für Augenheilkunde, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.
Lars-Olof
LO
Hattenbach
Marion
M
Brieden
Frank
F
Koch
Hermann
H
Gümbel
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005451:Fluorescein Angiography / Q000187:drug effects; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011994:Recombinant Proteins / Q000008:administration & dosage; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014792:Visual Acuity / Q000187:drug effects; D014822:Vitreous Body
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride