title: TISSUE PLASMINOGEN ACTIVATOR FOR SUBFOVEAL HEMORRHAGE DUE TO AGE-RELATED MACULAR DEGENERATION: Comparison of 3 Treatment Modalities.
abstract: OBJECTIVE
  To analyze and compare the effects of three common treatment modalities for a thick subfoveal hemorrhage due to exudative age-related macular degeneration on final visual acuity and the size of the final subretinal scar.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Single-site, tertiary referral center.
  
  
  METHODS
  Thirty-nine patients with exudative age-related macular degeneration and acute SMH greater than 250 μm.
  
  
  METHODS
  Patients received vitrectomy with a subretinal tissue plasminogen activator (tPA) injection, pneumatic displacement (PD) with intravitreal tPA, or PD without tPA within 2 weeks of presentation.
  
  
  METHODS
  Functional outcome was determined by Snellen visual acuity. Anatomical outcome was determined as the final disciform scar size.
  
  
  RESULTS
  Treatment groups did not differ in age, sex, initial visual acuity, the initial area of the thick subfoveal hemorrhage, follow-up duration, lens status, duration of exudative age-related macular degeneration, previous intravitreal bevacizumab injections, or time from last given injection to the acute thick subfoveal hemorrhage. Final visual acuity improved significantly in both the vitrectomy and subretinal tPA injection group (P < 0.001), and the intravitreal tPA injection group (P = 0.002) but not with PD alone. Patients treated with subretinal tPA achieved 40% ± 54% reduction in final scar area, in contrast to 27% ± 35% decrease in patients treated with intravitreal tPA (P = 0.001).
  
  
  CONCLUSIONS
  Treatment with tPA improves the functional and anatomical outcomes in patients with thick subfoveal hemorrhage due to subfoveal choroidal neovascular membrane secondary to exudative age-related macular degeneration and was superior to PD without tPA. Vitrectomy with subretinal tPA injection reduced the final disciform scar compared with PD with or without intravitreal tPA.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky.
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Fassbender
authors.forename: Mark P
authors.initials: MP
authors.lastname: Sherman
authors.forename: Charles C
authors.initials: CC
authors.lastname: Barr
authors.forename: Shlomit
authors.initials: S
authors.lastname: Schaal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058450:Endotamponade; D005122:Exudates and Transudates; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005466:Fluorocarbons / Q000008:administration & dosage; D005584:Fovea Centralis; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D062606:Tertiary Care Centers; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D057135:Wet Macular Degeneration / Q000150:complications* / Q000503:physiopathology
chemical_list: D005343:Fibrinolytic Agents; D005466:Fluorocarbons; C042852:perflutren; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride