Long-term visual outcome and its predictive factors following treatment of acute submacular hemorrhage with intravitreous injection of tissue plasminogen factor and gas.

Abstract

PURPOSE:

To investigate the long-term functional outcome and its predictive factors of treatment of acute submacular hemorrhage secondary to age-related macular degeneration with intravitreal application of recombinant tissue plasminogen activator (rt-PA) and gas.

METHODS:

Twenty-six patients were enrolled in the retrospective case series. A complete history and ocular examination, including fluorescein angiography, were performed. The best-corrected visual acuity was measured with a Snellen chart. Patients were followed up for 12 to 131 months (mean: 49 months). All patients underwent intravitreal injection of rt-PA (50 μg) and expansile gas. Primary outcome measures were best postoperative and final visual acuity and degree of blood displacement.

RESULTS:

The size of the subretinal hemorrhage ranged from 0.5 to 28 disc diameters, and the degree of blood displacement was defined as complete (≥1 disc area from the center of the fovea), partial, or no displacement. Twenty-one (81%) patients showed partial or complete displacement of hemorrhage. Due to lack of displacement of hemorrhage in 5 patients (19%), submacular surgery was performed. In 13 of 21 (62%; P=0.0001) patients with displacement of hemorrhage, the best postoperative visual acuity improved ≥2 lines. The final visual acuity improved ≥2 lines in 42.9% (9 of 21), was stable in 23.8% (5 of 21), and worse ≥2 lines in 33.3% (7 of 21) of patients. The short duration of hemorrhage (≤4 days) and complete displacement of blood, independent of the hemorrhage size, were significantly associated with better postoperative visual acuity (P=0.0001, P=0.0001, respectively).

CONCLUSION:

Intravitreal injection of rt-PA and gas seem to be more effective when applied within the first 4 days of acute submacular hemorrhage. Preoperative visual acuity as well as displacement of hemorrhage might be useful to predict final visual acuity.

• Authors: Bianka Sobolewska, Eray Utebey, Karl Ulrich Bartz-Schmidt, Olcay Tatar
• Journal: Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics (J Ocul Pharmacol Ther) Vol. 30 Issue 7 Pg. 567-72 (Sep 2014) ISSN: 1557-7732 [Electronic] United States
• PMID: 24821566 (Publication Type: Journal Article)

Chemical References

• Gases
• Tissue Plasminogen Activator

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Female
• Gases (administration & dosage, therapeutic use)
• Humans
• Intravitreal Injections
• Male
• Middle Aged
• Retinal Hemorrhage (drug therapy)
• Retrospective Studies
• Tissue Plasminogen Activator (administration & dosage, therapeutic use)
• Treatment Outcome