Clinical results about intravitreal tissue plasminogen activator (tPA) assisted gas displacement of subretinal hemorrhage in age related macular degeneration

Framme, Carsten and El Toukhy, Hesham and Sachs, Helmut G. and Spiegel, Detlef and Roider, Johann and Gabel, Veit-Peter and Lohmann, Chris P. (2000) Clinical results about intravitreal tissue plasminogen activator (tPA) assisted gas displacement of subretinal hemorrhage in age related macular degeneration. KLINISCHE MONATSBLATTER FUR AUGENHEILKUNDE, 216 (1). pp. 33-39. ISSN 0023-2165

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Abstract

Background: Subretinal hemorrhage in age related macular degeneration (AMD) usually causes acute visual loss and is associated with poor visual prognosis. In order to prevent retinal damage and to perform laser treatment of the underlying choroidal neovascularization (CNV) the subretinal hemorrhage has to be removed from the macular region. This could be achieved by intravitreal injection of tissue plasminogen activator (tPA) and gas. Patients and methods: In 8 consecutive patients, suffering from a massive macular hemorrhage (duration of visual problems: mean 9 days), tissue plasminogen activator (tPA) (40 mu g in 400 mu l BSS) and SF6-gas (0.75 ml) was transsclerally injected into the vitreous cavity to achieve liquification and displacement of the hemorrhage. Results: In all patients liquification and displacement of the hemorrhage out of the macular region was achieved during follow up. During the first week after operation a significant increase of visual acuity was noticed in all patients, however ophthalmoscopically there was just little reduction of the hemorrhage in the foveolar area. After successful removal of the blood the choroidal neovascularization was treated successfully by laser coagulation in one patient. No laser treatment was performed in the other patients because of the subfoveal location of the neovascularisation or because of disciform scar. Visual acuity increased 4 lines after surgery. In one case the procedure was complicated by a persistent vitreous hemorrhage and vitrectomy had to be performed in another patient due to an endophthalmitis. Conclusion: Intravitreal injection of tPA assisted gas displacement of subretinal hemorrhage due to AMD leads to a significant increase of visual acuity during the first week after operation. Although a nearly complete removal of the hemorrhage out of the macular area could be achieved, it was difficult to differentiate this from the spontaneous course. Laser photocoagulation could be performed in only few cases.

Item Type: Article
Uncontrolled Keywords: POSTVITRECTOMY FIBRIN FORMATION; SUBMACULAR HEMORRHAGE; NEOVASCULAR MEMBRANES; SURGICAL DRAINAGE; RETINAL TOXICITY; REMOVAL; MACULOPATHY; EVACUATION; PREVALENCE; MANAGEMENT; macular degeneration; choroidal neovascularization; subretinal hemorrhage; tPA
Subjects: 600 Technology > 610 Medical sciences Medicine
Divisions: Medicine > Lehrstuhl für Augenheilkunde
Depositing User: Dr. Gernot Deinzer
Date Deposited: 08 Jun 2022 07:11
Last Modified: 08 Jun 2022 07:11
URI: https://pred.uni-regensburg.de/id/eprint/43027

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