title: Subretinal coapplication of recombinant tissue plasminogen activator and bevacizumab for neovascular age-related macular degeneration with submacular haemorrhage.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of pars plana vitrectomy (ppV) with subretinal coapplication of recombinant tissue plasminogen activator (rtPA) and bevacizumab, and fluid-gas exchange for neovascular age-related macular degeneration (AMD) with submacular haemorrhage (SMH).
  
  
  METHODS
  Consecutive interventional case series of 12 patients with neovascular AMD with SMH with a maximum history of 14 days. All patients underwent ppV with subretinal coapplication of rtPA and bevacizumab, and fluid-gas (20% SF6) exchange. Phakic patients underwent concomitant cataract surgery. Additional injections of bevacizumab were applied intravitreally 4 and 8 weeks postop.
  
  
  RESULTS
  Complete displacement of SMH from the fovea was achieved in 9 of 12 patients. The mean best-corrected visual acuity (BCVA) improved significantly from preop logMAR 1.9 (range 3.0 to 0.7) to logMAR 1.2 (range 3.0 to 0.3) at 4 weeks postop (p = 0.01) and to logMAR 0.9 (range 1.6 to 0.2) at 12 weeks postop (p = 0.006). The mean improvement of BCVA 4 weeks postop as compared with preop was logMAR 0.7 (range -0.2 to 2.3). The mean improvement of BCVA 12 weeks postop as compared with preop was logMAR 0.96 (range -0.3 to 2.8). Overall, at 12 weeks postop, BCVA had improved in 10 patients, remained unchanged in one patient and worsened in one patient.
  
  
  CONCLUSIONS
  PpV with subretinal coapplication of rtPA and bevacizumab, and fluid-gas exchange effectively displaces SMH and improves visual acuity in most patients.
authors: Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Str 3, Haus 25, D-24105 Kiel, Germany.
authors: F
authors: F
authors: Treumer
authors: C
authors: C
authors: Klatt
authors: J
authors: J
authors: Roider
authors: J
authors: J
authors: Hillenkamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000209:etiology; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications; D008268:Macular Degeneration / Q000150:complications / Q000628:therapy*; D008297:Male; D011183:Postoperative Complications; D011994:Recombinant Proteins / Q000627:therapeutic use; D012166:Retinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D000068258:Bevacizumab; D010959:Tissue Plasminogen Activator