INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study

Jan H de Jong; Elsbeth J T van Zeeburg; Matteo G Cereda; Mirjam E J van Velthoven; Koorosh Faridpooya; Koenraad A Vermeer; Jan C van Meurs

doi:10.1097/IAE.0000000000000954

INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study

Jan H de Jong, Elsbeth J T van Zeeburg, Matteo G Cereda, Mirjam E J van Velthoven, Koorosh Faridpooya, Koenraad A Vermeer, Jan C van Meurs

Research output: Contribution to journal › Article › Research › peer-review

Abstract

PURPOSE: Current management of submacular hemorrhage (SMH) favors vitrectomy and gas with subretinal administration of recombinant tissue plasminogen activator (rtPA) over mere intravitreal rtPA injections and gas. In this study, we aimed to compare the effectiveness of both treatment modalities to displace submacular blood.

METHODS: Twenty-four patients with SMH secondary to age-related macular degeneration were included. The SMH had to exist ≤14 days at time of surgery and SMH thickness had to be between 250 μm and 1,250 μm. Patients were randomized to either intravitreal injections of rtPA, perfluoropropane (C3F8) gas, and bevacizumab (n = 12) or vitrectomy with subretinal rtPA administration, intravitreal C3F8 gas, and bevacizumab (n = 12). The SMH volume change was measured on spectral domain optical coherence tomography postoperatively within a 2.5-mm cylinder centered at the fovea.

RESULTS: Median relative volume reduction of subretinal blood at 6 weeks postoperatively was 97% (95% confidence interval: 91-99%) in the intravitreal rtPA group and 100% (95-100%) in the subretinal rtPA group and did not differ significantly between groups (P = 0.56).

CONCLUSION: Both treatment modalities effectively displaced SMH in this exploratory clinical trial. To more definitely study the noninferiority of intravitreal rtPA with gas to subretinal rtPA, vitrectomy with gas, a larger clinical trial would be necessary.

Original language	English
Pages (from-to)	914-25
Number of pages	12
Journal	Retina
Volume	36
Issue number	5
DOIs	https://doi.org/10.1097/IAE.0000000000000954
Publication status	Published - May 2016

Keywords

Acute Disease
Combined Modality Therapy
Endotamponade
Fibrinolytic Agents/administration & dosage
Fluorocarbons/administration & dosage
Humans
Injections, Intraocular
Intravitreal Injections
Prospective Studies
Recombinant Proteins/administration & dosage
Retinal Hemorrhage/diagnosis
Tissue Plasminogen Activator/administration & dosage
Tomography, Optical Coherence
Visual Acuity/physiology
Vitrectomy
Wet Macular Degeneration/complications

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de Jong, J. H., van Zeeburg, E. J. T., Cereda, M. G., van Velthoven, M. E. J., Faridpooya, K., Vermeer, K. A., & van Meurs, J. C. (2016). INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study. Retina, 36(5), 914-25. https://doi.org/10.1097/IAE.0000000000000954

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title = "INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study",

abstract = "PURPOSE: Current management of submacular hemorrhage (SMH) favors vitrectomy and gas with subretinal administration of recombinant tissue plasminogen activator (rtPA) over mere intravitreal rtPA injections and gas. In this study, we aimed to compare the effectiveness of both treatment modalities to displace submacular blood.METHODS: Twenty-four patients with SMH secondary to age-related macular degeneration were included. The SMH had to exist ≤14 days at time of surgery and SMH thickness had to be between 250 μm and 1,250 μm. Patients were randomized to either intravitreal injections of rtPA, perfluoropropane (C3F8) gas, and bevacizumab (n = 12) or vitrectomy with subretinal rtPA administration, intravitreal C3F8 gas, and bevacizumab (n = 12). The SMH volume change was measured on spectral domain optical coherence tomography postoperatively within a 2.5-mm cylinder centered at the fovea.RESULTS: Median relative volume reduction of subretinal blood at 6 weeks postoperatively was 97% (95% confidence interval: 91-99%) in the intravitreal rtPA group and 100% (95-100%) in the subretinal rtPA group and did not differ significantly between groups (P = 0.56).CONCLUSION: Both treatment modalities effectively displaced SMH in this exploratory clinical trial. To more definitely study the noninferiority of intravitreal rtPA with gas to subretinal rtPA, vitrectomy with gas, a larger clinical trial would be necessary.",

keywords = "Acute Disease, Combined Modality Therapy, Endotamponade, Fibrinolytic Agents/administration & dosage, Fluorocarbons/administration & dosage, Humans, Injections, Intraocular, Intravitreal Injections, Prospective Studies, Recombinant Proteins/administration & dosage, Retinal Hemorrhage/diagnosis, Tissue Plasminogen Activator/administration & dosage, Tomography, Optical Coherence, Visual Acuity/physiology, Vitrectomy, Wet Macular Degeneration/complications",

author = "{de Jong}, {Jan H} and {van Zeeburg}, {Elsbeth J T} and Cereda, {Matteo G} and {van Velthoven}, {Mirjam E J} and Koorosh Faridpooya and Vermeer, {Koenraad A} and {van Meurs}, {Jan C}",

year = "2016",

month = may,

doi = "10.1097/IAE.0000000000000954",

language = "English",

volume = "36",

pages = "914--25",

journal = "Retina",

issn = "0275-004X",

number = "5",

}

de Jong, JH, van Zeeburg, EJT, Cereda, MG, van Velthoven, MEJ , Faridpooya, K, Vermeer, KA & van Meurs, JC 2016, 'INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study', Retina, vol. 36, no. 5, pp. 914-25. https://doi.org/10.1097/IAE.0000000000000954

INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study. / de Jong, Jan H; van Zeeburg, Elsbeth J T; Cereda, Matteo G et al.
In: Retina, Vol. 36, No. 5, 05.2016, p. 914-25.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION

T2 - An Exploratory Prospective Study

AU - de Jong, Jan H

AU - van Zeeburg, Elsbeth J T

AU - Cereda, Matteo G

AU - van Velthoven, Mirjam E J

AU - Faridpooya, Koorosh

AU - Vermeer, Koenraad A

AU - van Meurs, Jan C

PY - 2016/5

Y1 - 2016/5

N2 - PURPOSE: Current management of submacular hemorrhage (SMH) favors vitrectomy and gas with subretinal administration of recombinant tissue plasminogen activator (rtPA) over mere intravitreal rtPA injections and gas. In this study, we aimed to compare the effectiveness of both treatment modalities to displace submacular blood.METHODS: Twenty-four patients with SMH secondary to age-related macular degeneration were included. The SMH had to exist ≤14 days at time of surgery and SMH thickness had to be between 250 μm and 1,250 μm. Patients were randomized to either intravitreal injections of rtPA, perfluoropropane (C3F8) gas, and bevacizumab (n = 12) or vitrectomy with subretinal rtPA administration, intravitreal C3F8 gas, and bevacizumab (n = 12). The SMH volume change was measured on spectral domain optical coherence tomography postoperatively within a 2.5-mm cylinder centered at the fovea.RESULTS: Median relative volume reduction of subretinal blood at 6 weeks postoperatively was 97% (95% confidence interval: 91-99%) in the intravitreal rtPA group and 100% (95-100%) in the subretinal rtPA group and did not differ significantly between groups (P = 0.56).CONCLUSION: Both treatment modalities effectively displaced SMH in this exploratory clinical trial. To more definitely study the noninferiority of intravitreal rtPA with gas to subretinal rtPA, vitrectomy with gas, a larger clinical trial would be necessary.

AB - PURPOSE: Current management of submacular hemorrhage (SMH) favors vitrectomy and gas with subretinal administration of recombinant tissue plasminogen activator (rtPA) over mere intravitreal rtPA injections and gas. In this study, we aimed to compare the effectiveness of both treatment modalities to displace submacular blood.METHODS: Twenty-four patients with SMH secondary to age-related macular degeneration were included. The SMH had to exist ≤14 days at time of surgery and SMH thickness had to be between 250 μm and 1,250 μm. Patients were randomized to either intravitreal injections of rtPA, perfluoropropane (C3F8) gas, and bevacizumab (n = 12) or vitrectomy with subretinal rtPA administration, intravitreal C3F8 gas, and bevacizumab (n = 12). The SMH volume change was measured on spectral domain optical coherence tomography postoperatively within a 2.5-mm cylinder centered at the fovea.RESULTS: Median relative volume reduction of subretinal blood at 6 weeks postoperatively was 97% (95% confidence interval: 91-99%) in the intravitreal rtPA group and 100% (95-100%) in the subretinal rtPA group and did not differ significantly between groups (P = 0.56).CONCLUSION: Both treatment modalities effectively displaced SMH in this exploratory clinical trial. To more definitely study the noninferiority of intravitreal rtPA with gas to subretinal rtPA, vitrectomy with gas, a larger clinical trial would be necessary.

KW - Acute Disease

KW - Combined Modality Therapy

KW - Endotamponade

KW - Fibrinolytic Agents/administration & dosage

KW - Fluorocarbons/administration & dosage

KW - Humans

KW - Injections, Intraocular

KW - Intravitreal Injections

KW - Prospective Studies

KW - Recombinant Proteins/administration & dosage

KW - Retinal Hemorrhage/diagnosis

KW - Tissue Plasminogen Activator/administration & dosage

KW - Tomography, Optical Coherence

KW - Visual Acuity/physiology

KW - Vitrectomy

KW - Wet Macular Degeneration/complications

U2 - 10.1097/IAE.0000000000000954

DO - 10.1097/IAE.0000000000000954

M3 - Article

C2 - 26807631

SN - 0275-004X

VL - 36

SP - 914

EP - 925

JO - Retina

JF - Retina

IS - 5

ER -

de Jong JH, van Zeeburg EJT, Cereda MG, van Velthoven MEJ , Faridpooya K, Vermeer KA et al. INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study. Retina. 2016 May;36(5):914-25. doi: 10.1097/IAE.0000000000000954