TY - JOUR
T1 - Combined treatment of acute subretinal haemorrhages with intravitreal recombined tissue plasminogen activator, expansile gas and bevacizumab
T2 - A retrospective pilot study
AU - Meyer, Carsten H.
AU - Scholl, Hendrik P.
AU - Eter, Nicole
AU - Helb, Hans Martin
AU - Holz, Frank G.
PY - 2008/8
Y1 - 2008/8
N2 - Purpose: To assess the effectiveness of consecutive intravitreal injections of recombined tissue plasminogen activator (rtPA), expansile gas and bevacizumab in eyes with acute subretinal haemorrhage (SRH). Methods: A retrospective, non-randomized consecutive case series included 19 eyes in 19 patients with SRH related to exudative age-related macular degeneration (AMD). The initial size of the subfoveal SRH was 1-3 disc diameters. Each patient received a triple procedure using 0.05ml rtPA (50μg), 0.3ml of sulphur hexafluoride (SF6) gas and 0.05ml bevacizumab (1.25mg). Lesion size, location of the SRH and early treatment in diabetic retinopathy study (ETDRS) visual acuity were evaluated pretreatment as well as 1 and 3 months after the procedure. Results: At the initial presentation, the patients' mean age was 77 years (range 63-88 years) and the mean duration of symptoms was 9.3 days (range 4-12 days). The mean visual acuity pretreatment (20/133) improved significantly to 20/86 at 1month and to 20/74 at 3 months. The mean ETDRS visual acuity improved from baseline by 2.1 lines at 1month (Wilcoxon ranks test; P < 0.005) and 3.7 lines at 3 months after treatment (Wilcoxon ranks test; P < 0.005). None of our patients had reading visual acuity prior to treatment, with visual acuity below 0.3. One month after the triple procedure, 25% of our patients had reading visual acuity (≥0.4); at 3 months, the figure was 35%. A successful inferior displacement of the SRH was achieved in 17/19 eyes. Eyes with elevated intraocular pressure were treated immediately by a corneal paracentesis. Conclusions: The intravitreal application of rtPA, gas and bevacizumab appears to be beneficial and well tolerated in the treatment of SRH in the short term. The triple approach seems a logical alternative to the current combined dual approach in limiting the progression of the underlying disease and achieving better visual outcome. Further randomized evaluations are warranted.
AB - Purpose: To assess the effectiveness of consecutive intravitreal injections of recombined tissue plasminogen activator (rtPA), expansile gas and bevacizumab in eyes with acute subretinal haemorrhage (SRH). Methods: A retrospective, non-randomized consecutive case series included 19 eyes in 19 patients with SRH related to exudative age-related macular degeneration (AMD). The initial size of the subfoveal SRH was 1-3 disc diameters. Each patient received a triple procedure using 0.05ml rtPA (50μg), 0.3ml of sulphur hexafluoride (SF6) gas and 0.05ml bevacizumab (1.25mg). Lesion size, location of the SRH and early treatment in diabetic retinopathy study (ETDRS) visual acuity were evaluated pretreatment as well as 1 and 3 months after the procedure. Results: At the initial presentation, the patients' mean age was 77 years (range 63-88 years) and the mean duration of symptoms was 9.3 days (range 4-12 days). The mean visual acuity pretreatment (20/133) improved significantly to 20/86 at 1month and to 20/74 at 3 months. The mean ETDRS visual acuity improved from baseline by 2.1 lines at 1month (Wilcoxon ranks test; P < 0.005) and 3.7 lines at 3 months after treatment (Wilcoxon ranks test; P < 0.005). None of our patients had reading visual acuity prior to treatment, with visual acuity below 0.3. One month after the triple procedure, 25% of our patients had reading visual acuity (≥0.4); at 3 months, the figure was 35%. A successful inferior displacement of the SRH was achieved in 17/19 eyes. Eyes with elevated intraocular pressure were treated immediately by a corneal paracentesis. Conclusions: The intravitreal application of rtPA, gas and bevacizumab appears to be beneficial and well tolerated in the treatment of SRH in the short term. The triple approach seems a logical alternative to the current combined dual approach in limiting the progression of the underlying disease and achieving better visual outcome. Further randomized evaluations are warranted.
KW - Bevacizumab
KW - Choroidal neovascularization
KW - Expansile gas
KW - Intravitreal injection recombined tissue plasminogen activator
KW - Subretinal haemorrhages
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U2 - 10.1111/j.1600-0420.2007.01125.x
DO - 10.1111/j.1600-0420.2007.01125.x
M3 - Article
C2 - 18221499
AN - SCOPUS:48449094548
SN - 1755-375X
VL - 86
SP - 490
EP - 494
JO - Acta Ophthalmologica
JF - Acta Ophthalmologica
IS - 5
ER -