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Impressum
Photodynamic therapy of subfoveal choroidal neovascularization in patients with ARMD after intravitreous injection of rt-PA and gas
Brieden M., Hattenbach L.-O., Kuhli C., Fischer I. B., Koch F.
Augenklinik, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, D- 60590 Frankfurt/Main
Objective: Submacular hemorrhage secondary to choroidal neovascularization
(CNV) in patients with age-related macular degeneration (ARMD) can cause
sudden visual loss. Several studies suggest that intravitreous injection
of recombinant tissue plaminogen activator (rt-PA) and gas is effective
in displacing submacular blood. The objective of the following investigation
was to determine the difference in visual outcome in patients, treated
with photodynamic therapy (PDT) after successful displacement of submacular
hemorrhage.
Patients and Methods: We examined 50 consecutive patients with
predominantly (>50%) classic CNV related to ARMD treated with PDT.
In ten of these patients (20%) localization of CNV and treatment with
PDT was performed after successful displacement of subretinal hemorrhage
with intravitreous injections of rt-PA (50µg) and sulfur hexafluoride
(0.5ml). Patient follow-up examinations were performed every 6 weeks to
3 months.
Results: By the end of the follow-up period visual acuity was improved
(>3 lines) in 2 patients. In 3 patients, a further deterioration (>3
lines) was observed, and in 45 patients, visual acuity remained stable.
Subgroup analyses revealed no difference with reference to visual outcome.
Conclusion: Our findings suggest that intravitreous injections
of rt-PA and gas constitute a valuable tool for the localization of choroidal
neovascular membranes amendable to further treatment with PDT in patients
with submacular hemorrage There appears to be no difference in visual
outcome compared to patients initially treated with PDT.