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Barzelay A, Daniels A, Cohen GY, Barak A, Schwartz S, Katz G. Pneumatic displacement with intravitreal tPA injection versus vitrectomy with sub retinal tPA injection in small and medium sub macular hemorrhages- a multicenter comparative study. BMC Ophthalmol 2024; 24:218. [PMID: 38773500 PMCID: PMC11106998 DOI: 10.1186/s12886-024-03468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/24/2024] [Indexed: 05/23/2024] Open
Abstract
PURPOSE Comparing between the visual outcomes and post operative complications of two surgical treatments for sub macular hemorrhage, pars plana vitrectomy with tissue plasminogen activator (tPA) injection procedure, and pneumatic displacement of submacular hemorrhage with intravitreal tPA injection. METHODS A retrospective chart review of patients with sub macular hemorrhage (SMH) was performed. Data was collected from 150 patients with sub macular hemorrhage. Patients were followed up from the day of admission and up to a year post surgery. Evaluation included visual acuity, optical coherence tomography (OCT), fundus examination and rates of complications. RESULTS Pars plana vitrectomy procedure has showed a better visual outcome in small SMH. Comparing complications between the two treatment modalities, no significant difference has been found in the study. CONCLUSIONS Pars plana vitrectomy and tPA showed a clear advantage with a trend of better visual acuity as well as a significant predictor to better visual acuity for small and medium sub macular hemorrhage.
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Affiliation(s)
- Aya Barzelay
- Tel Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Avishai Daniels
- Tel Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Gal Yaakov Cohen
- Sheba Medical Center, Ramat Gan, 5262100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Adiel Barak
- Tel Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Shulamit Schwartz
- Tel Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Gabriel Katz
- Sheba Medical Center, Ramat Gan, 5262100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
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Szeto SKH, Tsang CW, Mohamed S, Lee GKY, Lok JKH, Hui VWK, Tsang KK, Chen LJ, Brelen M, Lai TYY. Displacement of Submacular Hemorrhage Using Subretinal Cocktail Injection versus Pneumatic Displacement: A Real-World Comparative Study. Ophthalmologica 2024; 247:118-132. [PMID: 38408445 PMCID: PMC11160427 DOI: 10.1159/000537953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION The objective of this study was to compare the outcome of submacular hemorrhage (SMH) displacement using pneumatic displacement with intravitreal expansile gas versus pars plana vitrectomy (PPV) with subretinal injection of tissue plasminogen activator (tPA), anti-vascular endothelial growth factor (VEGF) agent, and air as primary surgery. METHODS Retrospective interventional case series of 63 patients who underwent surgical displacement of SMH secondary to neovascular age-related macular degeneration (nAMD) or polypoidal choroidal vasculopathy (PCV) from May 1, 2015, to October 31, 2022. Medical records were reviewed for diagnosis, logMAR visual acuity (VA), central subfield thickness (CST), and postoperative displacement rates and complications up to 12 months after operation. RESULTS The diagnosis was nAMD in 24 (38.1%) and PCV in 39 (61.9%) eyes. There were 40 (63.5%) eyes in the pneumatic displacement group (38 received C3F8, 2 received SF6) and 23 (36.5%) eyes in the subretinal cocktail injection. Mean baseline VA was 1.46 and 1.62, respectively (p = 0.404). The subretinal injection group had more extensive SMH (p = 0.005), thicker CST (1,006.6 μm vs. 780.2 μm, p = 0.012), and longer interval between symptom and operation (10.65 vs. 5.53 days, p < 0.001). The mean postoperative VA at 6 months was 0.67 and 0.91 (p = 0.180) for pneumatic displacement and subretinal injection groups, respectively, though VA was significantly better in the pneumatic group at 12-month visit (0.64 vs. 1.03, p = 0.040). At least 10 mean change in VA were >10 letters gain in both groups up to 12 months. Postoperative CST reduction was greater (625.1 μm vs. 326.5 μm, p = 0.008) and complete foveal displacement (87.0% vs. 37.5%), p < 0.001, odds ratio [OR] = 11.1) and displacement to arcade or beyond (52.5% vs. 17.5%, p = 0.009, OR = 5.15) were more frequent in the subretinal injection group. Two patients with failed pneumatic displacement were successfully treated with subretinal cocktail injection as a second operation. CONCLUSION Surgical displacement of SMH leads to clinically meaningful improvement in VA. PPV with subretinal cocktail injection is more effective than pneumatic displacement in displacing SMH with similar safety profile despite longer interval before operation, higher CST, and more extensive SMH at baseline. Retinal surgeons could consider this novel technique in cases with thick and extensive SMH or as a rescue secondary operation in selected cases.
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Affiliation(s)
- Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China,
- Hong Kong Eye Hospital, Hong Kong, Hong Kong, China,
- Pao So Kok Macular Disease Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China,
| | - Chi Wai Tsang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, Hong Kong, China
| | - Shaheeda Mohamed
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, Hong Kong, China
| | - Gary K Y Lee
- The Hong Kong Ophthalmic Associates, Hong Kong, Hong Kong, China
| | - Jerry K H Lok
- Hong Kong Ophthalmic Specialists, Hong Kong, Hong Kong, China
| | - Vivian W K Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, Hong Kong, China
| | - Ken K Tsang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Department of Ophthalmology, Prince of Wales Hospital, Hong Kong, Hong Kong, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Pao So Kok Macular Disease Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Department of Ophthalmology, Prince of Wales Hospital, Hong Kong, Hong Kong, China
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
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Gabrielle PH, Delyfer MN, Glacet-Bernard A, Conart JB, Uzzan J, Kodjikian L, Arndt C, Tadayoni R, Soudry-Faure A, Creuzot Garcher CP. Surgery, Tissue Plasminogen Activator, Antiangiogenic Agents, and Age-Related Macular Degeneration Study: A Randomized Controlled Trial for Submacular Hemorrhage Secondary to Age-Related Macular Degeneration. Ophthalmology 2023; 130:947-957. [PMID: 37088447 DOI: 10.1016/j.ophtha.2023.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023] Open
Abstract
PURPOSE To compare the efficacy and the safety of submacular hemorrhage (SMH) management using either surgical pars plana vitrectomy (PPV) or pneumatic displacement (PD) with tissue plasminogen activator (tPA) and vascular endothelial growth factor (VEGF) inhibitor added to each arm. DESIGN Randomized, open-label, multicenter superiority study. PARTICIPANTS Ninety patients with neovascular age-related macular degeneration (nAMD) 50 years of age or older with recent SMH (≤ 14 days) of more than 2 optic disc areas and predominantly overlying the retinal pigment epithelium. METHODS Patients were assigned randomly to surgery (PPV, subretinal tPA [maximum, 0.5 ml/50 μg], and 20% sulfur hexafluoride [SF6] tamponade) or PD (0.05 ml intravitreal tPA [50 μg] and 0.3 ml intravitreal pure SF6). Both groups were asked to maintain a head upright position with the face forward at 45° for 3 days after intervention and received 0.5 mg intravitreal ranibizumab at the end of the intervention, at months 1 and 2, as the loading phase, and then on a pro re nata regimen during a 6-month follow-up. MAIN OUTCOME MEASURES The primary efficacy endpoint was mean best-corrected visual acuity (VA) change at month 3. The secondary endpoints were mean VA change at month 6, 25-item National Eye Institute Visual Function Questionnaire composite score value at months 3 and 6, number of anti-VEGF injections, and complications during the 6-month follow-up. RESULTS Of the 90 patients randomized, 78 patients (86.7%) completed the 3-month efficacy endpoint visit. The mean VA change from baseline to month 3 in the surgery group (+16.8 letters [95% confidence interval (CI), 8.7-24.9 letters]) was not significantly superior to that in the PD group (+16.4 letters [95% CI, 7.1-25.7 letters]; adjusted difference β, 1.9 [-11.0; 14.9]; P = 0.767). Both groups achieved similar secondary outcomes at month 6. No unexpected ocular safety concerns were observed in either group. CONCLUSIONS Surgery did not yield superior visual gain nor additional benefit for SMH secondary to nAMD compared with PD at 3 months, with intravitreal anti-VEGF added to each arm. Both treatment strategies lead to a clinical improvement of VA without safety concerns for SMH over 6 months. Both design and results of the trial cannot be used to establish equivalence between treatments. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Marie-Noëlle Delyfer
- Department of Ophthalmology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Agnès Glacet-Bernard
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), Créteil, France
| | - Jean Baptiste Conart
- Department of Ophthalmology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Joel Uzzan
- Department of Ophthalmology, Clinique Mathilde, Rouen, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse Teaching Hospital, Hospices Civils de Lyon, Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Villeurbanne, France
| | - Carl Arndt
- Department of Ophthalmology, Robert Debré Hospital, Reims, France
| | - Ramin Tadayoni
- Department of Ophthalmology, Université Paris Cité, AP-HP, Lariboisière, Saint Louis and Adolphe de Rothschild Fondation Hospitals, Paris, France
| | - Agnès Soudry-Faure
- Department of Clinical Research and Innovation (DRCI), Clinical Research Unit Methodological Support Network (USMR), University Hospital, Dijon, France
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Loo J, Teo KY, Vyas CH, Jordan-Yu JMN, Juhari AB, Jaffe GJ, Cheung CMG, Farsiu S. Joint multimodal deep learning-based automatic segmentation of ICGA and OCT images for assessment of PCV biomarkers. OPHTHALMOLOGY SCIENCE 2023; 3:100292. [PMID: 37025946 PMCID: PMC10070921 DOI: 10.1016/j.xops.2023.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/08/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
Purpose To develop a fully-automatic hybrid algorithm to jointly segment and quantify biomarkers of polypoidal choroidal vasculopathy (PCV) on indocyanine green angiography (ICGA) and spectral domain-OCT (SD-OCT) images. Design Evaluation of diagnostic test or technology. Participants Seventy-two participants with PCV enrolled in clinical studies at Singapore National Eye Center. Methods The dataset consisted of 2-dimensional (2-D) ICGA and 3-dimensional (3-D) SD-OCT images which were spatially registered and manually segmented by clinicians. A deep learning-based hybrid algorithm called PCV-Net was developed for automatic joint segmentation of biomarkers. The PCV-Net consisted of a 2-D segmentation branch for ICGA and 3-D segmentation branch for SD-OCT. We developed fusion attention modules to connect the 2-D and 3-D branches for effective use of the spatial correspondence between the imaging modalities by sharing learned features. We also used self-supervised pretraining and ensembling to further enhance the performance of the algorithm without the need for additional datasets. We compared the proposed PCV-Net to several alternative model variants. Main Outcome Measures The PCV-Net was evaluated based on the Dice similarity coefficient (DSC) of the segmentations and the Pearson's correlation and absolute difference of the clinical measurements obtained from the segmentations. Manual grading was used as the gold standard. Results The PCV-Net showed good performance compared to manual grading and alternative model variants based on both quantitative and qualitative analyses. Compared to the baseline variant, PCV-Net improved the DSC by 0.04 to 0.43 across the different biomarkers, increased the correlations, and decreased the absolute differences of clinical measurements of interest. Specifically, the largest average (mean ± standard error) DSC improvement was for intraretinal fluid, from 0.02 ± 0.00 (baseline variant) to 0.45 ± 0.06 (PCV-Net). In general, improving trends were observed across the model variants as more technical specifications were added, demonstrating the importance of each aspect of the proposed method. Conclusion The PCV-Net has the potential to aid clinicians in disease assessment and research to improve clinical understanding and management of PCV. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Tiosano A, Gal-Or O, Fradkin M, Elul R, Dotan A, Hadayer A, Brody J, Ehrlich R. Visual acuity outcome in patients with subretinal hemorrhage - office procedure vs. surgical treatment. Eur J Ophthalmol 2023; 33:506-513. [PMID: 35532042 DOI: 10.1177/11206721221098208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the effects of intravitreal injection of tissue plasminogen activator (tPA) and gas vs. pars plana vitrectomy (PPV) surgery as first-line treatment for subretinal hemorrhage. METHODS Retrospective study of 107 adults treated for subretinal hemorrhage at a tertiary hospital during 2008-2019; 51 received injection of tPA and gas and 56 underwent PPV. RESULTS No between-group differences were found in age and sex, medical history, use of anticoagulants or antiplatelets, history of ocular surgeries, and previous use of intravitreal anti-VEGF. Overall follow-up time was longer in the PPV group (median 4.9 vs 3.28 years, p = 0.005). The hemorrhage was displaced in a similar percentage of patients in the tPA-and-gas group (n = 40, 78.4%) and the PPV group (n = 45, 80.4%) (p = 0.816). Approximately 80% of patients in the tPA-and-gas group were able to forgo PPV surgery. Visual acuity (in LogMAR) was similar in the two groups prior to the diagnosis of subretinal hemorrhage but better in the tPA-and-gas group at the end of follow-up (p < 0.001). CONCLUSION Injection of gas and tPA can be done immediately following diagnosis of subretinal hemorrhage as an office procedure. Visual acuity outcome is good, with a high rate of blood displacement. About 20% of patients might require additional PPV as secondary intervention.
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Affiliation(s)
- Alon Tiosano
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Orly Gal-Or
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Maayan Fradkin
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Rotem Elul
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Adelson Faculty of Medicine, 42732Ariel University, Ariel, Israel
| | - Assaf Dotan
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Amir Hadayer
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Judith Brody
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Rita Ehrlich
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
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Differences in clinical characteristics and treatment outcomes of submacular hemorrhage caused by age-related macular degeneration and retinal macroaneurysms: A multicenter survey from the Japan Clinical Retina Study (J-CREST) group. PLoS One 2022; 17:e0274508. [PMID: 36173964 PMCID: PMC9522260 DOI: 10.1371/journal.pone.0274508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
To evaluate the clinical characteristics, treatment trends, and visual prognosis of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD) and retinal arterial macroaneurysm (RAM).
Methods
This retrospective study enrolled 187 Japanese patients with SMH at 10 institutions from 2015 to 2018. Medical records including SMH etiology, best-corrected visual acuity (BCVA), fundus photographs, optical coherence tomography images, and selected treatments were analyzed.
Results
Major causes of SMH were typical nAMD (tnAMD) (18%), polypoidal choroidal vasculopathy (PCV) (50%) and RAM (29%). Age, male/female ratio, baseline BCVA, central retinal thickness, and involved retinal layers were significantly different between etiologies (all P<0.0001). Treatment with anti-vascular endothelial growth factor drugs with and without intravitreal gas injection was chosen for half of eyes in the tnAMD and PCV groups, whereas vitrectomy was performed in 83.7% of eyes with RAM. The final BCVA improved significantly from baseline in the PCV and RAM groups (P = 0.0009, P<0.0001) and final BCVA was significantly better in the PCV group at a level similar to the other groups (P = 0.0007, P = 0.0008). BCVA improvement from baseline was significantly greater in the RAM group compared with the tnAMD (P = 0.0152) and PCV (P = 0.017) groups. Multivariate analysis revealed better final BCVA was significantly associated with younger age (P = 0.0054), better baseline BCVA (P = 0.0021), RAM subtype (P = 0.0446), and no tnAMD (P = 0.001).
Conclusions
The characteristics of, and treatment strategy for, SMH were different between the underlying diseases. Anti-vascular endothelial growth factor treatment with or without expansile gas was mainly chosen for SMH in tnAMD and PCV, whereas vitrectomy with gas was the most common treatment for RAM, and the higher rate for vitrectomy might result in the greater BCVA improvement in the RAM group than in the other groups. Final BCVA was better in PCV, RAM, and tnAMD, in that order, because patients with PCV were younger and had better baseline BCVA.
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Fayzrakhmanov RR, Bosov ED, Shishkin MM, Voropaev VY, Sukhanova AV, Chekhonin ES, Mironov AV. [Modern aspects of the treatment of submacular hemorrhages secondary to macular degeneration]. Vestn Oftalmol 2022; 138:87-93. [PMID: 35488566 DOI: 10.17116/oftalma202213802187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Age-related macular degeneration complicated by submacular hemorrhage if not treated timely leads to permanent loss of central vision. The basis of effective therapy is its early start, dislocation of blood from central parts of the retina and blockage of neovascularization. This review examines the current methods of treatment of submacular hemorrhages, anatomical and functional outcomes, risks of postoperative complications, as well as trends in the use of combined methods of surgical intervention.
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Affiliation(s)
| | - E D Bosov
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - M M Shishkin
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | | | - A V Sukhanova
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - E S Chekhonin
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - A V Mironov
- Svyatoslav Fedorov Foundation for the Promotion of Advanced Medical Technologies, Moscow, Russia
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One-Year Outcome of Intravitreal Tissue Plasminogen Activator, Ranibizumab, and Gas Injections for Submacular Hemorrhage in Polypoidal Choroidal Vasculopathy. J Clin Med 2022; 11:jcm11082175. [PMID: 35456268 PMCID: PMC9032067 DOI: 10.3390/jcm11082175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/26/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
This study investigated one-year outcomes of treatment with one session of intravitreal recombinant tissue plasminogen activator, ranibizumab, and gas injections for submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). An extended study of a previous prospective trial of this treatment modality in PCV patients was conducted in 64 patients (64 eyes). Early Treatment Diabetic Retinopathy Study (ETDRS) score, central retinal thickness (CRT), and central pigment epithelial detachment thickness (CPEDT) before and 1, 3, and 12 months after treatment were analyzed. Mean ETDRS score increased from 58 at baseline to 64 letters (p = 0.0122), CRT decreased from 543 to 192 μm (p < 0.0001), and CPEDT decreased from 161 to 103 μm (p = 0.0668) at 3 months and were maintained until 12 months. Complications requiring reoperation occurred within one month in four eyes. Recurrence was observed in 46 eyes (72%), and 1.6 ± 1.5 (0−7) intravitreal aflibercept injections were given pro re nata. Univariate and multivariate analyses identified CPEDT as the pre- and post-treatment factor affecting 12-month ETDRS score (p < 0.0001). Improved visual acuity stabilized 3 months after treatment. Although 72% of patients experienced recurrence, an average of 1.6 aflibercept injections/patient maintained visual acuity up to 12 months. CPEDT was the most important factor associated with visual outcome.
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Fukuda Y, Nakao S, Kohno RI, Ishikawa K, Shimokawa S, Shiose S, Takeda A, Morizane Y, Sonoda KH. Postoperative follow-up of submacular hemorrhage displacement treated with vitrectomy and subretinal injection of tissue plasminogen activator: ultrawide-field fundus autofluorescence imaging in gas-filled eyes. Jpn J Ophthalmol 2022; 66:264-270. [PMID: 35260984 DOI: 10.1007/s10384-022-00910-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the utility of Optos ultrawide-field fundus autofluorescence (UWF-FAF) imaging for postoperative follow-up of gas-filled eyes after vitrectomy with subretinal tissue-plasminogen activator (t-PA) injection for subretinal hemorrhage (SRH) displacement. STUDY DESIGN Retrospective consecutive case series. METHODS This study included 24 eyes with SRH. Vitrectomy with subretinal t-PA injection was performed, followed by postoperative prone positioning. FAF images acquired using Optos California were examined and the SRH occupancy in the macula was calculated. The main outcome measures were displacement rate and direction of SRH for 3 days postoperatively, and postoperative best-corrected visual acuity (BCVA). RESULTS The postoperative BCVA ranged from improvement (23 eyes; 95.8%) to no change (one eye; 4.2%). Analysis was done using postoperative Optos FAF images for 20 eyes (83.3%). Postoperative SRH occupancy was significantly reduced, by 27.4%, compared with the preoperative occupancy (P = 0.03). A statistically significant reduction was found between the preoperative and postoperative day (POD)1 (P = 0.04), but not between POD1 and POD2 (P = 0.7), or between POD2 and POD3 (P = 1.0). CONCLUSION UWF-FAF imaging is useful for postoperative follow-up of gas-filled eyes after vitrectomy with subretinal t-PA injection for SRH displacement.
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Affiliation(s)
- Yosuke Fukuda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Ophthalmology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Ophthalmology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan. .,Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan.
| | - Ri-Ichiro Kohno
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keijiro Ishikawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sakurako Shimokawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satomi Shiose
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Macular Hemorrhage Due to Age-Related Macular Degeneration or Retinal Arterial Macroaneurysm: Predictive Factors of Surgical Outcome. J Clin Med 2021; 10:jcm10245787. [PMID: 34945083 PMCID: PMC8703651 DOI: 10.3390/jcm10245787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: The study aimed to determine the outcomes and prognostic factors of vitrectomy, subretinal injection of tissue-plasminogen activator and gas tamponade in macular hemorrhage (MaH) due to age-related macular degeneration (AMD) or retinal arterial macroaneurysm (RAM). Methods: The study design utilized a multicentric retrospective case series design of consecutive patients undergoing surgery between 2014 and 2019. Results: A total of 65 eyes from 65 patients were included in the study. Surgery was performed after a mean period of 7.1 days. Displacement of MaH was achieved in 82% of the eyes. Mean best-corrected visual acuity (BCVA) improved from 20/500 to 20/125 at month(M)1 and M6 (p < 0.05). At M6, BCVA worsening was associated with an older age at diagnosis (p = 0.0002) and higher subretinal OCT elevation of MaH (p = 0.03). The use of treat and extend (TE) (OR = 16.7, p = 0.001) and small MaH fundus size (OR = 0.64 and 0.74 for horizontal and vertical fundus size, p < 0.05) were predictive of a higher likelihood of obtaining a countable BCVA at M1. Baseline BCVA was predictive of postoperative BCVA (p < 0.05). Retinal detachment and MaH recurrence occurred in 3% and 9.3% of cases at M6. Conclusion: MaH surgery stabilizes or improves BCVA in 85% of cases. Younger age at diagnosis, better baseline BCVA figures, smaller subretinal MaH height and use of TE regime were predictive of the best postoperative outcomes.
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Wang T, Xia J, Yuan M, Wu X, Zhu Y, Chen C, Bergunder SJ, Liu Z, Chen W, Huang K, Lin H. Hypertension affects the treatment of wet age-related macular degeneration. Acta Ophthalmol 2021; 99:871-876. [PMID: 33787087 PMCID: PMC9544391 DOI: 10.1111/aos.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/16/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
Purpose Due to population ageing as well as the high prevalence of hypertension and age‐related macular degeneration (AMD) in elderly individuals, and the relationship between hypertension and AMD is unclear. Our research aimed to investigate the association between hypertension, wet AMD (wAMD) and the treatment strategy of wAMD patients affected by hypertension. Methods Data of wAMD patients at Zhongshan Ophthalmic Center, Sun Yat‐sen University, between 1 January 2002 and 30 June 2019, were extracted from the electronic healthcare information system. wAMD patients were divided into subgroups by hypertension status, age, sex, the need for vitrectomy surgery and the number of anti‐VEGF drug intravitreal injections that these were divided in 1–3 vs. >3 (available time from 1 January 2012 to 30 June 2019). Results A total of 3096 wAMD patients (41.7% female, 58.3% male) with an age range of 50–96 years (68.7 (SD 9.42) years) were included. wAMD was significantly associated with hypertension (p < 0.001). After adjustment for sex and age, Cox regression model showed a significant association between hypertension in wAMD patients and the number of injections (RR = 1.31, 95% CI: 1.13–1.50, p < 0.001). There was no significant association between hypertension and the need for vitrectomy (p = 0.82). Conclusions wet AMD was associated with hypertension status, and after the regular series of three injections, wAMD patients with hypertension were more likely to receive anti‐VEGF drug intravitreal injections than those without hypertension. These results may facilitate prospective research on the prevention of wAMD and contribute to the management of wAMD patients.
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Affiliation(s)
- Ting Wang
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Jun Xia
- Key Laboratory of Machine Intelligence and Advanced Computing Sun Yat‐sen University Guangzhou China
| | - Meng Yuan
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology University of Miami Miller School of Medicine Miami FL USA
| | - Chuan Chen
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami FL USA
| | - Sean J. Bergunder
- Jihua laboratory R&D Center for Ophthalmic Cutting‐Edge Technology and Medical Devices Foshan Guangdong China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Wenben Chen
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Kai Huang
- Key Laboratory of Machine Intelligence and Advanced Computing Sun Yat‐sen University Guangzhou China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
- Center for Precision Medicine Sun Yat‐sen University Guangzhou China
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Arthur A, Rajasekaran NM, Kuriakose T. A reappraisal of indirect choroidal rupture using swept-source optical coherence tomography in-vivo pathology images in patients with blunt eye trauma. Indian J Ophthalmol 2021; 68:2131-2135. [PMID: 32971624 PMCID: PMC7728025 DOI: 10.4103/ijo.ijo_2192_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To describe the in-vivo pathology of indirect choroidal rupture (ICR) in patients with recent ocular trauma using swept-source optical coherence tomography (SSOCT). Methods Retrospective observational study of the presenting and follow-up OCT images of four consecutive Asian patients with blunt trauma presenting over a period of 6 months and review of OCT descriptions in the literature. Results The three patients who presented within 2 weeks of injury showed a gap in the Bruch's membrane (BM)/retinal pigment epithelial complex at the site of the ICR. The distance of the gap ranged from 103 to 465 μm. Blood from associated tear in the choriocapillary layer dissected under the photoreceptor layer to lift it off the retinal pigment epithelium (RPE) layer. The Sattler's and Haller's layers of the choroid were not affected. Fibro-vascular proliferation occurring in the reparative phase bridges the gap in the BM, RPE complex. Late fibrous tissue proliferation extends into the Sattler's layer in the choroid and goes up to the outer nuclear layer in the retina disrupting its architecture. Conclusion SSOCT is a useful tool to study the pathology of recent onset ICR as it is capable of imaging through blood. The primary injury in ICR seems to be a break in the Bruch's membrane. The RPE layer and choriocapillaries get disrupted secondary to the break in the BM as their basement membranes are part of the BM. Scarring during the reparative phase disrupts the adjacent layers of the choroid and retina.
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Affiliation(s)
- Anupriya Arthur
- Department of Eye, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Thomas Kuriakose
- Department of Eye, Christian Medical College, Vellore, Tamil Nadu, India
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Rickmann A, Paez LR, della Volpe Waizel M, Bisorca-Gassendorf L, Schulz A, Vandebroek AC, Szurman P, Januschowski K. Functional and structural outcome after vitrectomy combined with subretinal rtPA Injection with or without additional intravitreal Bevacizumab injection for submacular hemorrhages. PLoS One 2021; 16:e0250587. [PMID: 33930041 PMCID: PMC8087026 DOI: 10.1371/journal.pone.0250587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background To analyze the functional and anatomical outcome after vitrectomy with subretinal rtPA (recombinant tissue plasminogen activator) combined with or without an intravitreal Bevacizumab injection. Patients and methods Retrospective, consecutive case series of 31 pseudophakic patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (AMD) treated with vitrectomy, subretinal rtPA and pneumatic air displacement with or without an additional intravitreal Bevacizumab injection. The primary endpoints were best-corrected visual acuity (BCVA), and central macular thickness (CMT) measured by SD‑OCT. The secondary endpoint was a displacement of hemorrhage from the subretinal space three months after surgery. Results 31 eyes of 31 patients were treated with vitrectomy and subretinal rtPA. 17/31 were treated simultaneously with an intravitreal Bevacizumab injection (group +B) and 14/31 without (group -B). The mean visual acuity improved significantly in both groups (from 1.37±0.39 to 1.03±0.57 logMAR in +B and from 1.48±0.48 to 1.01±0.38 logMAR in group –B, p<0.05). The mean CMT decreased in group +B from 607±179 μm to 424±205 μm (p = 0.2) and in group –B from 722±216 μm to 460±202 μm (p<0.05). A central displacement of the hemorrhage could be achieved in 47% in group +B, whereas in group -B displacement could be achieved in 50% (p = 0.44). Conclusions Vitrectomy with subretinal rtPA injection and air tamponade with or without simultaneous intravitreal Bevacizumab injection displaces SMH and improves BCVA effectively. In comparison, the postoperative outcome is comparable regardless of whether or not intravitreal bevacizumab is applied simultaneously.
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Affiliation(s)
- Annekatrin Rickmann
- Depatment of Ophthalmology, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
- * E-mail:
| | - Lina R. Paez
- Depatment of Ophthalmology, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
| | | | | | - André Schulz
- Depatment of Ophthalmology, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
| | | | - Peter Szurman
- Depatment of Ophthalmology, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
| | - Kai Januschowski
- Depatment of Ophthalmology, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
- Depatment of Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany
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Saito-Uchida S, Inoue M, Koto T, Kato Y, Hirakata A. Vitrectomy combined with subretinal injection of tissue plasminogen activator for successful treatment of massive subretinal hemorrhage. Eur J Ophthalmol 2020; 31:2588-2595. [PMID: 33148019 DOI: 10.1177/1120672120970404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the outcome of vitrectomy combined with a subretinal injection of tissue plasminogen activator (tPA) to treat a massive subretinal hemorrhage. METHODS The medical records of 11 eyes of 11 patients (seven men, four women, mean age; 74.5 ± 9.6 years) with a massive (>10 disc area) subretinal hemorrhage were reviewed. The patients were treated with vitrectomy combined with a subretinal injection of tPA with or without external drainage. RESULTS The mean baseline visual acuity was 2.10 ± 0.45 logarithm of the minimum angle of resolution (logMAR) units. The hemorrhage was externalized in three eyes due to bullous hemorrhagic retinal detachment. The subretinal hemorrhage was displaced away from the fovea in 10 eyes (91%) and reduced in one eye. Retinal reattachment was achieved in all eyes however reoperations were needed in five eyes (45%) among the eight eyes (73%) with recurrent vitreous and/or subretinal hemorrhages. The postoperative vision at 3 months was significantly improved to 1.32 ± 0.65 logMAR units (p = 0.0076). The vision in the two eyes without postoperative subretinal hyperreflective material at the fovea recovered to 0.4 logMAR units but none of the nine eyes with the foveal subretinal hyperreflective material had vision better than 0.1 logMAR units. CONCLUSION Vitrectomy with subretinal injection of tPA with or without external drainage of the subretinal hemorrhage was effective in treating massive subretinal hemorrhages.
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Affiliation(s)
- Shoko Saito-Uchida
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Makoto Inoue
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Takashi Koto
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yu Kato
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Akito Hirakata
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Management of a Submacular Hemorrhage Secondary to Age-Related Macular Degeneration: A Comparison of Three Treatment Modalities. J Clin Med 2020; 9:jcm9103088. [PMID: 32987903 PMCID: PMC7601376 DOI: 10.3390/jcm9103088] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
This paper aims to compare the effects of three treatment modalities for a submacular hemorrhage (SMH) secondary to exudative age-related macular degeneration (AMD). Seventy-seven patients with an SMH were divided into three groups: small-sized (optic disc diameter (ODD) ≥ 1 to < 4), medium-sized (ODD ≥ 4 within the temporal arcade) and large-sized (ODD ≥ 4, exceeding the temporal arcade). Patients received anti-vascular endothelial growth factor (anti-VEGF) monotherapy, pneumatic displacement (PD) with anti-VEGF or a vitrectomy with a subretinal tissue plasminogen activator (tPA) and gas tamponade based on the surgeon’s discretion. The functional and anatomical outcomes were evaluated. Among the 77 eyes, 45 eyes had a small-sized, 21 eyes had a medium-sized and 11 eyes had a large-sized SMH. In the small-sized group, all treatment modalities showed a gradual best-corrected visual acuity (BCVA) improvement with high hemorrhagic regression or displacement rates (over 75%). In the medium-sized group, PD and surgery were associated with better BCVA with more displacement than anti-VEGF monotherapy (67% and 83%, respectively, vs. 33%). In the large-sized group, surgery showed a better visual improvement with a higher displacement rate than PD (86% vs. 25%). Our findings demonstrated that visual improvement can be expected through appropriate treatment strategy regardless of the SMH size. In cases with a larger SMH, invasive techniques including PD or surgery were more advantageous than anti-VEGF monotherapy.
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Wilkins CS, Mehta N, Wu CY, Barash A, Deobhakta AA, Rosen RB. Outcomes of pars plana vitrectomy with subretinal tissue plasminogen activator injection and pneumatic displacement of fovea-involving submacular haemorrhage. BMJ Open Ophthalmol 2020; 5:e000394. [PMID: 32201733 PMCID: PMC7076260 DOI: 10.1136/bmjophth-2019-000394] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/13/2020] [Accepted: 02/19/2020] [Indexed: 11/22/2022] Open
Abstract
Objective Fovea-involving subretinal haemorrhage is challenging to manage with uncertain visual outcomes. We reviewed outcomes of patients with fovea-involving macular haemorrhage treated with pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) with pneumatic displacement. Methods and Analysis This is a retrospective interventional case series. All patients with submacular haemorrhage who underwent PPV with subretinal tPA injection were included. Reasons for exclusion encompassed patients who underwent intravitreal tPA injection in the office without surgery, insufficient follow-up or documentation. Primary outcomes of interest were postoperative visual acuity (VA) at month 1 and 3. Secondary outcomes were median VA at month 3 by location of haemorrhage and underlying diagnosis. Results Thirty-seven total patients were included. The mean age was 68.2 years, with 54.1% (20/37) females. The most common aetiology was exudative macular degeneration (43.2%), followed by undifferentiated choroidal neovascularisation (CNV) (18.9%), polypoidal choroidal vasculopathy (18.9%), traumatic CNV (10.8%), macroaneurysm (5.4%) and proliferative diabetic retinopathy (2.7%). Median preoperative VA was 20/2000, postoperative month 1 was 20/347 (p<0.01), improving to 20/152 (p<0.01) at month 3. Proportion of patients gaining vision 3+ lines in vision was 15/36 (42%). Mean preoperative central subfield thickness on optical coherence tomography was 512.2 µm for sub-retinal pigment epithelium haemorrhage and 648.2 µm for subretinal haemorrhage (p=0.48). Difference in VA by diagnosis was not significant (p=0.60). Conclusions PPV with subretinal tPA injection and pneumatic displacement of submacular haemorrhage offers modest visual recovery for a diverse group of patients. Location of haemorrhage or specific diagnosis may not predict outcome.
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Affiliation(s)
- Carl S Wilkins
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Neesurg Mehta
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Chris Y Wu
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Alexander Barash
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | | | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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Berthon C, Rousseau E, Chiambaretta F. [Treatment of submacular hematoma by vitrectomy, subretinal injection of rtPA and gaseous tamponade: A single-center retrospective observational study]. J Fr Ophtalmol 2020; 43:417-426. [PMID: 32192752 DOI: 10.1016/j.jfo.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the functional and anatomic recovery of submacular hemorrhage (SMH), treated with vitrectomy, subretinal injection of rtPA and gas tamponade, to highlight the risk factors for their occurrence as well as the factors influencing prognosis. MATERIALS AND METHODS This is a single-center retrospective study. Thirty-two eyes of 30 patients from the Clermont-Ferrand University Hospital were included, with a submacular hemorrhage (SMH) requiring surgical evacuation. The primary endpoint was final postoperative visual recovery. Visual acuities (AV) were converted to the logarithmic minimum angle of resolution scale (logMAR) for statistical analysis. RESULTS The average time from onset of symptoms to surgery was 4.8±3.3 days. The initial VA was 2.1±0.3 logMAR, with an average improvement of 0.7±0.7 logMAR (P=0.0004) at the final visit. The mean thickness of the SMH decreased by 729±352μm (P<0.0001) at the final visit. CONCLUSION Treatment of SMH with vitrectomy, subretinal injection of rtPA and gas tamponade results in a statistically significant improvement in final VA, as well as a significant decrease in SMH thickness on OCT.
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Affiliation(s)
- C Berthon
- CHU de Gabriel Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - E Rousseau
- CHU de Gabriel Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - F Chiambaretta
- CHU de Gabriel Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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Lu AQ, Prensky JG, Baker PS, Scott IU, Mahmoud TH, Todorich B. Update on medical and surgical management of submacular hemorrhage. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1725474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Amy Q. Lu
- Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Ingrid U. Scott
- Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Tamer H. Mahmoud
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, and Associated Retinal Consultants, PC, Royal Oak, MI, USA
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Sniatecki JJ, Ho-Yen G, Clarke B, Barbara R, Lash S, Papathomas T, Antonakis S, Gupta B. Treatment of submacular hemorrhage with tissue plasminogen activator and pneumatic displacement in age-related macular degeneration. Eur J Ophthalmol 2019; 31:643-648. [PMID: 31813290 DOI: 10.1177/1120672119891625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate visual and anatomic outcomes following pars plana vitrectomy and intravitreal or subretinal tissue plasminogen activator for submacular hemorrhage in patients with age-related macular degeneration. METHODS This was a retrospective study on patients with a minimum follow-up of 12 months undertaken at a tertiary referral center. Data collected include demographic details, visual and optical coherence tomography changes, surgical details, and complications. Surgical results were compared with patients who were age and lesion size matched and treated with anti-vascular endothelial growth factor injections alone. RESULTS There were 36 patients in surgical and 18 patients in control group. Patients in surgical arm had pars plana vitrectomy, intravitreal tissue plasminogen activator with air 24 (67%), 6 (16%) with C3F8 gas, 1 (3%) with SF6 gas, 4 (11%) subretinal tissue plasminogen activator with air, and 1 (3%) with C2F6 as post-operative tamponade. Mean LogMAR in tissue plasminogen activator group at baseline was 1.56, and it was improved at all time points 1.06 at 1 month (p < 0.05), 0.91 at 6 months (p < 0.05), and 1.07 at 1 year (p < 0.05). Mean best corrected visual acuity in control group at baseline was 1.22LogMAR with no significant improvement at any time points: 1 month (1.27), 6 months (1.35), and 12 months (1.36). Complications included retinal detachment 5%, vitreous hemorrhage 7.5%, and cataract 19%. CONCLUSION Pars plana vitrectomy with intravitreal (or subretinal) tissue plasminogen activator and pneumatic displacement can offer better outcome in comparison to anti-vascular endothelial growth factor alone in patients with submacular hemorrhage secondary to age-related macular degeneration.
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Affiliation(s)
| | - Gregory Ho-Yen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Benjamin Clarke
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ramez Barbara
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Lash
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas Papathomas
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Bhaskar Gupta
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kimura S, Morizane Y, Hosokawa MM, Shiode Y, Doi S, Hosogi M, Fujiwara A, Okanouchi T, Inoue Y, Shiraga F. Outcomes of vitrectomy combined with subretinal tissue plasminogen activator injection for submacular hemorrhage associated with polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2019; 63:382-388. [PMID: 31243593 DOI: 10.1007/s10384-019-00679-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To examine the outcomes of vitrectomy with subretinal tissue plasminogen activator (tPA) injection and postoperative intravitreal antivascular endothelial growth factor (VEGF) injection for submacular hemorrhage (SMH) associated with polypoidal choroidal vasculopathy (PCV). STUDY DESIGN Retrospective, consecutive case series. METHODS Patients who underwent vitrectomy for SMH associated with PCV and who were followed up for at least 12 months were included. Surgery consisted of vitrectomy with subretinal tPA and air tamponade. Postoperative intravitreal anti-VEGF was administered pro re nata. The following were examined: best-corrected visual acuity (BCVA) at baseline, at 1 month, and at the final visit; the percentage of patients requiring anti-VEGF postoperatively; and the number of injections administered. RESULTS This study included 23 eyes of 23 patients (21 men, 2 women) with a mean age of 72.5 ± 9.0 years. The mean duration from disease onset to surgery was 9.0 ± 6.6 days. The mean maximum SMH size was 5.8 ± 4.8 disc diameters. The mean follow-up period was 33 ± 14 months. The BCVA was significantly improved when compared with baseline 1 month after surgery and at the final visit. Postoperative anti-VEGF was required for 91% of the eyes. In eyes that underwent anti-VEGF therapy until the final visit, the mean injection number was 4.1/year. CONCLUSIONS Vitrectomy with subretinal tPA and air tamponade improved visual acuity in patients with SMH associated with PCV. Postoperative intravitreal anti-VEGF injection maintained the improved BCVA throughout a mean period of 33 months.
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Affiliation(s)
- Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Mio Morizane Hosokawa
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichiro Doi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Mika Hosogi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsushi Fujiwara
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | | | | | - Fumio Shiraga
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Kimura M, Yasukawa T, Shibata Y, Kato A, Hirano Y, Uemura A, Yoshida M, Ogura Y. Flattening of retinal pigment epithelial detachments after pneumatic displacement of submacular hemorrhages secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2018; 256:1823-1829. [PMID: 29961921 DOI: 10.1007/s00417-018-4059-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Pneumatic displacement of submacular hemorrhages (SMHs) with intravitreal injection of sulfur hexafluoride (SF6) gas with or without tissue plasminogen activator (tPA) and prone posturing is an effective minimally invasive treatment. We observed some cases in which simultaneous flattening of hemorrhagic pigment epithelial detachments (PEDs) occurred after prone posturing. This study evaluated the impact of pneumatic displacement using tPA to treat PEDs and visual outcomes in eyes with SMHs secondary to neovascular age-related macular degeneration (AMD). METHODS This retrospective analysis reviewed the medical records of 32 patients (33 eyes) who underwent pneumatic displacement for AMD-associated SMHs. The SMHs were related to polypoidal choroidal vasculopathy (PCV) in 24 eyes and typical AMD in nine eyes and treated with intravitreal injection of SF6 gas with tPA. We assessed the postoperative best-corrected visual acuities (BCVAs), prevalence and flattening rates of the PEDs, and the number of additional treatments. RESULTS The mean follow-up period was 35.4 ± 19.8 months. The BCVAs improved significantly in eyes with PCV compared with eyes with typical AMD. Thirty-one (93.9%) of 33 eyes had an accompanying PED. The PEDs flattened in 14 (58.3%) of 24 eyes with PCV but in only one (14.3%) of seven eyes with typical AMD (p = 0.04). A mean of one additional treatment was administered during the first year in 15 eyes with flattened PEDs, which was significantly (p < 0.05) fewer than the 3.6 additional treatments in 16 eyes with persistent PEDs. CONCLUSIONS PEDs often accompany SMHs secondary to neovascular AMD. Pneumatic displacement of the SMHs using tPA unexpectedly flattened the PEDs, especially in eyes with PCV, and was associated with fewer additional treatments.
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Affiliation(s)
- Masayo Kimura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Yu Shibata
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Aki Kato
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Akiyoshi Uemura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Munenori Yoshida
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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