With emerging performance of minimally invasive vitrectomy techniques the use of silicone oil with low viscosity in patients with conceivable endurance of the endotamponade appears to be beneficial. Up to now 10 patients have undergone 23 gauge vitrectomy with application of 2000 cs silicone oil without any complications in our clinic. In contrast, two cases demonstrated early emulsification of the 2000 cs silicone oil. To the best of our knowledge this complication has not been described before.
Retinal angiomatous proliferation (RAP) is a subtype of exudative age-related macular degeneration which is characterized by an intraretinal origin of the lesion and a particularly poor prognosis. In this retrospective case study 33 eyes from 33 patients with stage III RAP lesions were included and initially treated with 3 intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Criteria for extended treatment were visual deterioration, fresh bleeding, residual fluid or increase of the central retinal thickness in optical coherence tomography (OCT) as well as persisting activity in fluorescence angiography (FLA). The follow-up period was 8 months. The mean best corrected visual acuity (BCVA) increased insignificantly from logMAR 0.71 at the start of therapy to logMAR 0.67 after the first 3 intravitreal treatment injections and remained stable up to 8 months. The mean decrease of the central retinal thickness after 4 months (-90 µm) and after 8 months (-70 µm) was significant. Of the patients included in the study 67 % were treated repeatedly and the mean frequency of reinjections was 2.27 injections after 8 months. The intravitreal injection of ranibizumab in patients with stage III RAP lesions resulted in functional and anatomical stabilization. In most cases repeated treatment is necessary which underlines the urgent need for close surveillance in follow-up.
Purpose To evaluate the effect of 23‐gauge core ppV with consecutive intravitreal injection of rtPA, gas and bevacizumab for the displacement of SRH in patients with exudative age‐related macular degeneration (AMD).
Methods The retrospective, non‐randomized case study included 15 eyes of 15 patients aged 74 to 89 with SRH resulting from exsudative AMD. Each patient was treated with 23‐gauge ppV and injection of 0.05 ml rtPA (50 μg), 0.3 ml of sulphur hexafluoride (SF6) gas and 0.05 ml bevacizumab (1.25 mg). Visual acuity (VA), lesion size measured by fluorescein angiography (FA) and retinal thickness as determined by optical coherence tomography (OCT) were evaluated pretreatment as well as 1, 3 and 6 months postoperatively.
Results The mean visual acuity pretreatment was 20/400. The figure remained constant until month 3 postoperatively. At 6 months, the mean VA had improved to 20/200. No patient had reading ability before treatment. 1 month postoperatively reading VA was achieved in 6 %, rising to 27% at 6 months. There was a reduction in retinal thickness in 8 patients measured by OCT. FA showed a reduction of lesion size in 10 out of 15 patients.
Conclusion The combined application of rtPA, gas and bevacizumab via 23‐gauge PPV for the treatment of SRH secondary to exudative AMD appears to be a safe and effective method. In our study, the combined treatment including the injection of bevacizumab enabled 27 % of patients to achieve reading ability at 6 months postoperatively.
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