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Impressum
Pneumatic displacement of submacular hemorrhages secondary to age-related macular degeneration: Intravitreal injection of rt-PA and gas versus gas alone
Hattenbach L. O., Kacer B., Gümbel H., Koch F.
Klinik für Augenheilkunde, Klinikum der Johann Wolfgang Goethe Universität, D-60590 Frankfurt am Main
Purpose: Recent studies have provided evidence that intravitreal
injections of the fibrinolytic agent recombinant tissue plasminogen activator
(rt-PA) and expansile gas may be effective in displacing submacular hemorrhages
secondary to age-related macular degeneration. However, it has been suggested
that the injection of gas alone may be equally effective. The objective
of our study was to compare the efficacy of these therapeutic approaches.
Methods: In a prospective randomized study, 24 consecutive eyes
of 24 patients with recent (</= 28 days) submacular hemorrhage secondary
to agerelated macular degeneration and severe visual loss were treated
with intravitreal injections of rt-PA (50 µg) and sulfur hexafluoride
(0.5 ml) or hexafluoride alone. The size of the subretinal hemorrhage
ranged from 1/4 to 10 disc areas. Patient follow-up ranged from 3 to 12
months.
Results: Among those patients who received intravitreal injections
of rt-PA and gas, best postoperative visual acuity compared with preoperative
visual acuity was improved two or more Snellen lines in 50% of cases.
Of those patients who received gas alone, 33% showed a comparable improvement.
Subgroup analysis for only those eyes with duration of hemorrhage >7
d revealed that there was a tendency for the rt-PA group to have better
visual recovery (50% vs. 20%). In one patient (rt-PA) a breakthrough vitreous
hemorrhage was observed.
Discussion: Our findings suggest that both, intravitreal injections
of rt-PA and sulfur hexafluoride or gas alone, are of value for an improved
and accelerated visual recovery in ARMD patients with submacular hemorrhage.
Intravitreal injections of gas alone appear to be less effective in patients
with onset of hemorrhage >7 days prior to therapy.