title: Submacular combination treatment for management of acute, massive submacular hemorrhage in age-related macular degeneration.
abstract: A surgical technique is described combining submacular anti-vascular endothelial growth factor (anti-VEGF) and recombinant tissue plasminogen activator (r-TPA) with pneumatic displacement of massive submacular hemorrhage in age-related macular degeneration. An 84-year-old man with a large, acute submacular hemorrhage secondary to age-related macular degeneration underwent combination vitrectomy, submacular anti-VEGF and r-TPA injection with pneumatic displacement of the hemorrhage. At the last follow-up visit, 7 months after surgery, visual acuity was 20/80 with a small fibrovascular pigment epithelial detachment and atrophic retinal pigment epithelial changes. A 77-year-old woman with known age-related macular degeneration underwent a similar surgical procedure for a similar acute, large submacular hemorrhage related to age-related macular degeneration. Nine months after surgery, the visual acuity was 20/70(-1). Combination submacular anti-VEGF therapy delivered at the time of pars plana vitrectomy and submacular tissue plasminogen activator assisted hemorrhage displacement may be a viable treatment strategy for the management massive submacular hemorrhage.
authors.affiliation: Jules Stein Eye Institute, Department of Ophthalmology University of California, David Geffen School of Medicine, Los Angeles, California 90095, USA.
authors.forename: Sumit P
authors.initials: SP
authors.lastname: Shah
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Hubschman
authors.forename: Christine R
authors.initials: CR
authors.lastname: Gonzales
authors.forename: Steven D
authors.initials: SD
authors.lastname: Schwartz
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D006801:Humans; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D000069579:Ranibizumab; D011994:Recombinant Proteins / Q000627:therapeutic use; D012166:Retinal Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014821:Vitrectomy
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D010959:Tissue Plasminogen Activator; D000069579:Ranibizumab