Vitrectomy for the treatment of submacular hemorrhages from macular degeneration: a comparison of submacular hemorrhage/membrane removal and submacular tissue plasminogen activator-assisted pneumatic displacement.
OBJECTIVE
To evaluate two techniques for treatment of large submacular hemorrhages resulting from choroidal neovascularization associated with age-related macular degeneration.


METHODS
Retrospective consecutive case series of 42 eyes of 42 patients who presented with submacular hemorrhages of at least 12 disc areas associated with visual loss of 3 months or less duration. One of two treatments was performed: (1) vitrectomy with removal of the submacular hemorrhage/neovascular membrane complex using subretinal forceps (SRH group), or (2) vitrectomy with injection of subretinal tissue plasminogen activator (TPA) followed by air-fluid exchange to achieve pneumatic displacement of the hemorrhage (TPA group).


RESULTS
The mean visual acuity in the SRH group improved from 20/1000 -1 to 20/640 -2 at 3 months and 20/640 at 1 year and at the final examination at a mean of 2.92 years (P = .048). The mean visual acuity in the TPA group remained stable initially with a visual acuity of 20/500 preoperatively and 20/640 +2 at 3 months. The visual acuity in the TPA group deteriorated to 20/1000 -2 at 1 year and 20/1000 +2 at the final examination at a mean of 2.3 years (P = .031). Visual acuity improved by at least .3 logMAR units (3 lines) in 44% of the SRH group at 3 months and in 48% at 1 year and at the final examination compared with 20% of the TPA group at 3 months and 13% at 1 year and at the final examination (P = .042 comparing SRH and TPA groups at 1 year and final examination).


CONCLUSIONS
Vitrectomy with removal of the subretinal neovascular membrane/hemorrhage complex resulted in better visual results than displacement of the subretinal hemorrhage primarily due to continuing declines in the TPA group.
Thompson
John T
JT
Retina Specialists, Greater Baltimore Medical Center, Baltimore, Maryland, USA.
Sjaarda
Raymond N
RN
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007267:Injections; D008266:Macula Lutea; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D008297:Male; D012160:Retina / Q000187:drug effects; D012166:Retinal Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013525:Surgical Instruments; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects / Q000295:instrumentation
D010959:Tissue Plasminogen Activator