title: Management of thick submacular hemorrhage with subretinal tissue plasminogen activator and pneumatic displacement for age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate the outcome of pars plana vitrectomy, subretinal tissue plasminogen activator (t-PA) infusion and intraocular gas tamponade with and without postsurgical antivascular endothelial growth factor (VEGF) injection for thick submacular hemorrhage due to exudative age-related macular degeneration (AMD).
  
  
  METHODS
  Retrospective, comparative, interventional case series.
  
  
  METHODS
  setting: 2 retina referral centers. The patient population included 101 eyes of 101 patients with neovascular AMD and thick submacular hemorrhage who underwent surgical displacement of the hemorrhage with or without postoperative anti-VEGF injections. Main outcome measures included degree of blood displacement, best and final postoperative visual acuity (VA), and adverse events. Snellen acuity was converted to logMAR for statistical analysis.
  
  
  RESULTS
  All patients were followed for a minimum of 3 months (mean, 15.3 months, range, 3-70 months). In 83 (82%) of 101 eyes, the procedure resulted in complete hemorrhage displacement from the fovea. Mean preoperative VA was 20/2255 (2.05 logMAR). The acuity significantly improved to 20/893 (1.65 logMAR) at month 1 (P < 0.001) at month 1; 20/678 (1.53 logMAR) at month 3 (P < 0.001), and 20/1150 (1.76 logMAR) at month 12 (P = 0.002). Best postoperative visual acuity improved by at least 1 line in 83 (82%) of 101 eyes, and 19.6% of eyes gained 3 lines or more at month 3. The visual acuity of the group of eyes that received postoperative anti-VEGF injection (n = 39) showed greater visual acuity improvement 6 months postoperatively compared to the group of eyes that did not receive postoperative anti-VEGF. Postoperative complications included vitreous hemorrhage in 2 eyes, rhegmatogenous retinal detachment in 4 eyes, and recurrent thick subretinal hemorrhage in 6 eyes.
  
  
  CONCLUSIONS
  Vitrectomy with subretinal t-PA injection and gas tamponade was found to be relatively effective for displacement of thick submacular hemorrhage with a significant improvement in visual acuity. There is a loss of acuity over time; the addition of postoperative anti-VEGF therapy may help maintain the visual acuity gains.
authors: Mid-Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA.
authors: Woohyok
authors: W
authors: Chang
authors: Mid-Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA. Electronic address: sunirgarg@yahoo.com.
authors: Sunir J
authors: SJ
authors: Garg
authors: Midwest Eye Institute, Indianapolis, IN.
authors: Raj
authors: R
authors: Maturi
authors: Mid-Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA.
authors: Jason
authors: J
authors: Hsu
authors: Mid-Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA.
authors: Arunan
authors: A
authors: Sivalingam
authors: Mid-Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA.
authors: Seema A
authors: SA
authors: Gupta
authors: Mid-Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA.
authors: Carl D
authors: CD
authors: Regillo
authors: Mid-Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA.
authors: Allen C
authors: AC
authors: Ho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D003131:Combined Modality Therapy; D058450:Endotamponade; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D057135:Wet Macular Degeneration / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D005343:Fibrinolytic Agents; D005466:Fluorocarbons; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C042852:perflutren; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride