Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration. American journal of ophthalmology. [Am J Ophthalmol] Journal article | | Title | Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration. | | Author(s) | Haupert CL, McCuen BW, Jaffe GJ, Steuer ER, Cox TA, Toth CA, Fekrat S, Postel EA | | Institution | Duke University Eye Center, Durham, North Carolina 27710, USA. | | Source | Am J Ophthalmol 2001 Feb; 131(2):208-15. | | MeSH | Aged
Aged, 80 and over
Female
Fibrinolytic Agents
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Injections
Macular Degeneration
Male
Recurrence
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Retinal Hemorrhage
Retrospective Studies
Sulfur Hexafluoride
Tissue Plasminogen Activator
Treatment Outcome
Visual Acuity
Vitrectomy
| | Abstract | PURPOSE: To evaluate a new procedure for displacement of large, thick submacular hemorrhage in patients with age-related macular degeneration.
METHODS: Retrospective review of 11 eyes of 11 patients with age-related macular degeneration and thick submacular hemorrhage (defined as causing retinal elevation detectable on stereo fundus photographs) treated with vitrectomy, subretinal injection of tissue plasminogen activator (25 or 50 microg), and fluid-gas exchange with postoperative prone positioning. Outcome measures included displacement of hemorrhage from the fovea, best postoperative visual acuity, and final postoperative visual acuity.
RESULTS: In the 11 affected eyes of 11 patients (seven men and four women; mean age, 76 years), preoperative visual acuity ranged from 20/200 to hand motions. With surgery, subretinal hemorrhage was displaced from the fovea in all 11 cases. Mean postoperative follow-up was 6.5 months (range, 1 to 15 months). Best postoperative visual acuity varied from 20/30 to 5/200, with improvement in nine (82%) cases and no change in two cases. Eight eyes (73%) measured 20/200 or better, with four of these eyes (36%) 20/80 or better. Final postoperative visual acuity ranged from 20/70 to light perception, with improvement in eight (73%) cases, no change in one case, and worsening in two cases. A statistically significant difference was found between preoperative and best postoperative visual acuity (P =.004) but not between preoperative and final visual acuity (P =.16). Hemorrhage recurred in three (27%) eyes, causing severe visual loss in one eye.
CONCLUSIONS: This technique displaces submacular hemorrhage from the fovea and can improve vision in patients with age-related macular degeneration. However, recurrence of hemorrhage occurred in 27% of eyes and caused severe visual loss in one eye. A randomized, prospective clinical trial is necessary to determine the efficacy of this technique in comparison with other proposed treatments. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 11228297 |
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