Effects of intravitreal gas with or without tissue plasminogen activator on submacular haemorrhage in age-related macular degeneration.
OBJECTIVE
To compare the anatomic and functional outcomes of treating thick submacular haemorrhage with intravitreal gas injection with and without tissue plasminogen activator (t-PA) in patients with age-related macular degeneration.


METHODS
A review of age-related macular degeneration patients with submacular haemorrhage who underwent intravitreal gas injection with and without t-PA at a tertiary referral centre was conducted. Main outcome measures were best and final postoperative visual acuity.


RESULTS
A total of 53 eyes of 53 patients were included, 28 eyes received intravitreal t-PA and gas injection (t-PA and gas group) and 25 eyes received intravitreal gas injection alone (gas-alone group). Incidence of best visual acuity improvement was significantly higher in the t-PA and gas group than in the gas-alone group (60.7 vs 32.0%; P=0.037). However, subgroup analysis demonstrated that the difference was significant only in eyes with haemorrhage duration of more than 14 days (46.2 vs 8.3%; P=0.035). Incidence of final visual acuity improvement was not significantly different between the two groups (42.9 vs 28.0%; P=0.39). The complications of vitreous haemorrhage and endophthalmitis were similar between the two groups. Multiple logistic regression analysis demonstrated that shorter haemorrhage duration (<14 days) was the main factor predictive of best visual acuity improvement (OR=9.02, P=0.015). Whether t-PA was used was of borderline significance (OR=4.96, P=0.046).


CONCLUSIONS
Intravitreal t-PA was valuable for submacular haemorrhage only in eyes with relatively old haemorrhage. For eyes with recent onset of emorrhage, t-PA is suggested only if initial gas injection failed to displace submacular haemorrhage.
Fang
I-M
IM
Department of Ophthalmology, National Taiwan University Hospital, Taipei.
Lin
Y-C
YC
Yang
C-H
CH
Yang
C-M
CM
Chen
M-S
MS
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005466:Fluorocarbons / Q000627:therapeutic use; D005740:Gases / Q000627:therapeutic use*; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011994:Recombinant Proteins / Q000627:therapeutic use; D012166:Retinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000627:therapeutic use; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity; D014822:Vitreous Body
D005343:Fibrinolytic Agents; D005466:Fluorocarbons; D005740:Gases; D011994:Recombinant Proteins; C042852:perflutren; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride