title: In-patient management and treatment satisfaction after intravitreous plasminogen activator injection.
abstract: OBJECTIVE
  To assess patient satisfaction after intravitreous plasminogen activator injections for subretinal hemorrhages secondary to age-related macular degeneration (AMD) and to analyse how it relates to the patients' postoperative visual and functional abilities. Further, to suggest ways to improve in-patient management and thereby treatment satisfaction.
  
  
  METHODS
  A consecutive series of 101 patients with a subretinal hemorrhage of at least one disk diameter were enrolled in this longitudinal prospective study conducted during 2001-2004. After complete preoperative eye examination all patients were treated with intravitreal injection of 25 microg recombinant tissue plasminogen activator (rTPA) and 0.5 ml sulphur hexafluoride gas (SF6), followed by face-down positioning for 1 week. Patient satisfaction was assessed using standardised questionnaires administered postoperatively at 4 and 12 months. Outcome measures were: (1) responses to the patient satisfaction survey, (2) degree of satisfaction with in-patient management, (3) subjective change in the patients' functional status, and (4) visual acuity results.
  
  
  RESULTS
  Whereas the patients' actual functional status deteriorated from a median value of 2.4 at 4 months to 3.4 at 12 months, their recall of their preoperative functional status shifted from a median value of 4.2 to to 2.3, consecutively. Twelve months after treatment, 75% of patients reported an improved visual acuity, however, only 12% reported satisfaction with treatment. 67.4-87% of patients were dissatisfied with various areas of in-patient management.
  
  
  CONCLUSIONS
  Satisfaction with plasminogen activator injection treatment is low even though patients experience an improved visual and functional status at 12 months. This suggests that the current system requires improvement in certain areas such as in-patient management.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Maneli
authors.initials: M
authors.lastname: Mozaffarieh
authors.forename: Harald
authors.initials: H
authors.lastname: Heinzl
authors.forename: Stefan
authors.initials: S
authors.lastname: Sacu
authors.forename: Andreas
authors.initials: A
authors.lastname: Wedrich
mesh_terms: D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D007297:Inpatients; D008268:Macular Degeneration / Q000150:complications; D017060:Patient Satisfaction; D016684:Prone Position; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology*; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride