Tissue plasminogen activator plus gas injection in patients with subretinal hemorrhage caused by age-related macular degeneration: predictive variables for visual outcome.
OBJECTIVE
To assess factors predicting final visual outcome after displacement of subretinal hemorrhage (SRH) by intravitreally injected tissue plasminogen activator (TPA) and gas in patients suffering from age-related macular degeneration (ARMD).


METHODS
We evaluated retrospectively the records of 67 patients (32 men, 35 women, mean age 77.2 years) suffering from SRH caused by ARMD who underwent TPA and gas injection between April 1996 and October 2000. Visual acuity (VA; preoperative, 1 week and 3 months postoperative) was analyzed with respect to duration and dimension of bleeding (diameter and thickness) and patient's age.


RESULTS
Mean preoperative VA was 0.063, compared with 0.1 at 3 months after injection. Twenty-nine of 47 patients (76%) had an increase in VA 1 week after treatment but 14 of these eyes worsened slightly during follow-up. Visual outcome 3 months after therapy was negatively correlated to thickness ( P<0.05) and diameter ( P<0.001) of the SRH. In a statistical model of a multiple regression analysis, postoperative VA and the shift of VA could be predicted by preoperative VA and diameter of SRH. Patient's age, duration and thickness of SRH had no prognostic value for postoperative visual outcome.


CONCLUSIONS
After SRH caused by ARMD, the best visual outcome after TPA + gas injection can be expected in patients with preoperative VA of less than 0.1 caused by a small SRH. In the presence of large SRH (diameter >5 mm) an increase in VA after therapy is unlikely.
Schulze
Stephan D
SD
Department of Ophthalmology, Philipps University Marburg, Robert Koch Strasse 4, 35033 Marburg, Germany. stephan.schulze5@epost.de
Hesse
Lutz
L
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005466:Fluorocarbons / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000627:therapeutic use*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy; D014822:Vitreous Body / Q000187:drug effects
D005466:Fluorocarbons; C042852:perflutren; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride