Vitrectomy for the treatment of submacular hemorrhages from macular degeneration: A comparison of submacular hemorrhage/membrane removal and submacular tissue plasminogen activator-assisted pneumatic displacement

John T. Thompson, Raymond N. Sjaarda, William F. Mieler

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate two techniques for treatment of large submacular hemorrhages resulting from choroidal neovascularization associated with age-related macular degeneration. Methods: Retrospective consecutive case series of 42 eyes of 42 patients who presented with submacular hemorrhages of at least 12 disc areas associated with visual loss of 3 months or less duration. One of two treatments was performed: (1) vitrectomy with removal of the submacular hemorrhage/neovascular membrane complex using subretinal forceps (SRH group), or (2) vitrectomy with injection of subretinal tissue plasminogen activator (TPA) followed by air-fluid exchange to achieve pneumatic displacement of the hemorrhage (TPA group). Results: The mean visual acuity in the SRH group improved from 20/1000 -1 to 20/640 -2 at 3 months and 20/640 at 1 year and at the final examination at a mean of 2.92 years (P = .048). The mean visual acuity in the TPA group remained stable initially with a visual acuity of 20/500 preoperatively and 20/640 +2 at 3 months. The visual acuity in the TPA group deteriorated to 20/1000 -2 at 1 year and 20/1000 +2 at the final examination at a mean of 2.3 years (P = .031). Visual acuity improved by at least .3 logMAR units (3 lines) in 44% of the SRH group at 3 months and in 48% at 1 year and at the final examination compared with 20% of the TPA group at 3 months and 13% at 1 year and at the final examination (P = .042 comparing SRH and TPA groups at 1 year and final examination). Conclusions: Vitrectomy with removal of the subretinal neovascular membrane/hemorrhage complex resulted in better visual results than displacement of the subretinal hemorrhage primarily due to continuing declines in the TPA group.

Original languageEnglish (US)
Pages (from-to)98-107
Number of pages10
JournalTransactions of the American Ophthalmological Society
Volume103
StatePublished - 2005
Externally publishedYes

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Vitrectomy
Macular Degeneration
Tissue Plasminogen Activator
Hemorrhage
Visual Acuity
Membranes
Therapeutics
Choroidal Neovascularization
Surgical Instruments
Air
Injections

ASJC Scopus subject areas

  • Ophthalmology

Cite this

@article{6160615823ca491d9e1ad7d552e3c30e,
title = "Vitrectomy for the treatment of submacular hemorrhages from macular degeneration: A comparison of submacular hemorrhage/membrane removal and submacular tissue plasminogen activator-assisted pneumatic displacement",
abstract = "Purpose: To evaluate two techniques for treatment of large submacular hemorrhages resulting from choroidal neovascularization associated with age-related macular degeneration. Methods: Retrospective consecutive case series of 42 eyes of 42 patients who presented with submacular hemorrhages of at least 12 disc areas associated with visual loss of 3 months or less duration. One of two treatments was performed: (1) vitrectomy with removal of the submacular hemorrhage/neovascular membrane complex using subretinal forceps (SRH group), or (2) vitrectomy with injection of subretinal tissue plasminogen activator (TPA) followed by air-fluid exchange to achieve pneumatic displacement of the hemorrhage (TPA group). Results: The mean visual acuity in the SRH group improved from 20/1000 -1 to 20/640 -2 at 3 months and 20/640 at 1 year and at the final examination at a mean of 2.92 years (P = .048). The mean visual acuity in the TPA group remained stable initially with a visual acuity of 20/500 preoperatively and 20/640 +2 at 3 months. The visual acuity in the TPA group deteriorated to 20/1000 -2 at 1 year and 20/1000 +2 at the final examination at a mean of 2.3 years (P = .031). Visual acuity improved by at least .3 logMAR units (3 lines) in 44{\%} of the SRH group at 3 months and in 48{\%} at 1 year and at the final examination compared with 20{\%} of the TPA group at 3 months and 13{\%} at 1 year and at the final examination (P = .042 comparing SRH and TPA groups at 1 year and final examination). Conclusions: Vitrectomy with removal of the subretinal neovascular membrane/hemorrhage complex resulted in better visual results than displacement of the subretinal hemorrhage primarily due to continuing declines in the TPA group.",
author = "Thompson, {John T.} and Sjaarda, {Raymond N.} and Mieler, {William F.}",
year = "2005",
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T1 - Vitrectomy for the treatment of submacular hemorrhages from macular degeneration

T2 - A comparison of submacular hemorrhage/membrane removal and submacular tissue plasminogen activator-assisted pneumatic displacement

AU - Thompson, John T.

AU - Sjaarda, Raymond N.

AU - Mieler, William F.

PY - 2005

Y1 - 2005

N2 - Purpose: To evaluate two techniques for treatment of large submacular hemorrhages resulting from choroidal neovascularization associated with age-related macular degeneration. Methods: Retrospective consecutive case series of 42 eyes of 42 patients who presented with submacular hemorrhages of at least 12 disc areas associated with visual loss of 3 months or less duration. One of two treatments was performed: (1) vitrectomy with removal of the submacular hemorrhage/neovascular membrane complex using subretinal forceps (SRH group), or (2) vitrectomy with injection of subretinal tissue plasminogen activator (TPA) followed by air-fluid exchange to achieve pneumatic displacement of the hemorrhage (TPA group). Results: The mean visual acuity in the SRH group improved from 20/1000 -1 to 20/640 -2 at 3 months and 20/640 at 1 year and at the final examination at a mean of 2.92 years (P = .048). The mean visual acuity in the TPA group remained stable initially with a visual acuity of 20/500 preoperatively and 20/640 +2 at 3 months. The visual acuity in the TPA group deteriorated to 20/1000 -2 at 1 year and 20/1000 +2 at the final examination at a mean of 2.3 years (P = .031). Visual acuity improved by at least .3 logMAR units (3 lines) in 44% of the SRH group at 3 months and in 48% at 1 year and at the final examination compared with 20% of the TPA group at 3 months and 13% at 1 year and at the final examination (P = .042 comparing SRH and TPA groups at 1 year and final examination). Conclusions: Vitrectomy with removal of the subretinal neovascular membrane/hemorrhage complex resulted in better visual results than displacement of the subretinal hemorrhage primarily due to continuing declines in the TPA group.

AB - Purpose: To evaluate two techniques for treatment of large submacular hemorrhages resulting from choroidal neovascularization associated with age-related macular degeneration. Methods: Retrospective consecutive case series of 42 eyes of 42 patients who presented with submacular hemorrhages of at least 12 disc areas associated with visual loss of 3 months or less duration. One of two treatments was performed: (1) vitrectomy with removal of the submacular hemorrhage/neovascular membrane complex using subretinal forceps (SRH group), or (2) vitrectomy with injection of subretinal tissue plasminogen activator (TPA) followed by air-fluid exchange to achieve pneumatic displacement of the hemorrhage (TPA group). Results: The mean visual acuity in the SRH group improved from 20/1000 -1 to 20/640 -2 at 3 months and 20/640 at 1 year and at the final examination at a mean of 2.92 years (P = .048). The mean visual acuity in the TPA group remained stable initially with a visual acuity of 20/500 preoperatively and 20/640 +2 at 3 months. The visual acuity in the TPA group deteriorated to 20/1000 -2 at 1 year and 20/1000 +2 at the final examination at a mean of 2.3 years (P = .031). Visual acuity improved by at least .3 logMAR units (3 lines) in 44% of the SRH group at 3 months and in 48% at 1 year and at the final examination compared with 20% of the TPA group at 3 months and 13% at 1 year and at the final examination (P = .042 comparing SRH and TPA groups at 1 year and final examination). Conclusions: Vitrectomy with removal of the subretinal neovascular membrane/hemorrhage complex resulted in better visual results than displacement of the subretinal hemorrhage primarily due to continuing declines in the TPA group.

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