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 -