title: Vitrectomy with subretinal tissue plasminogen activator and ranibizumab for submacular haemorrhages secondary to age-related macular degeneration: retrospective case series of 45 consecutive cases.
abstract: PurposeTo assess the efficacy of small-gauge vitrectomy with subretinal recombinant tissue plasminogen activator (rtPA) and ranibizumab for submacular haemorrhages secondary to neovascular age-related macular degeneration (nAMD), and to identify the factors associated with visual outcome.MethodsA retrospective case series was performed, including all patients who had small-gauge vitrectomy with subretinal rtPA and ranibizumab for submacular haemorrhages secondary to nAMD. All patients received three consecutive monthly injections of ranibizumab after the surgery, and were reviewed monthly and treated on a pro re nata regime.ResultsA total of 45 eyes of 45 patients were included in the study. Mean age was 77.07±9.67 years, and 32 of 45 patients (71.1%) were women. Surgery was performed on average 6.98±5.70 days after the onset of symptoms, and patients were observed for a follow-up period of 12.9±10.8 months. On average, visual acuity improved -0.59±0.61 LogMAR between presentation and last follow-up. Visual acuity improved in 33 patients (73.3%), remained unchanged in 10 patients (22.2%), and worsened in 2 patients (4.4%). Multiple linear regression showed that patients with smaller haemorrhages (P=0.012) and prompt surgery (P=0.008) had better final visual acuities. A haemorrhage area of ≤30 mm(2) had 91.3% sensitivity and 73.3% specificity for predicting a final visual acuity ≥6/60.ConclusionSmall-gauge vitrectomy with subretinal rtPA and ranibizumab is effective for improving visual acuity in patients with submacular haemorrhages secondary to nAMD. Small haemorrhage area and prompt surgery are associated with better final visual acuity.
authors.affiliation: Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: González-López
authors.affiliation: Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, UK.
authors.forename: G
authors.initials: G
authors.lastname: McGowan
authors.affiliation: Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, UK.
authors.forename: E
authors.initials: E
authors.lastname: Chapman
authors.affiliation: Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, UK.
authors.forename: D
authors.initials: D
authors.lastname: Yorston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000069579:Ranibizumab / Q000627:therapeutic use*; D012160:Retina / Q000187:drug effects; D012166:Retinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D057135:Wet Macular Degeneration / Q000150:complications / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D005343:Fibrinolytic Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D010959:Tissue Plasminogen Activator; D000069579:Ranibizumab