Current Management of Subretinal Hemorrhage in Neovascular Age-Related Macular Degeneration

Oncel, Damla; Oncel, Deniz; Mishra, Kapil; Oncel, Murat; Arevalo, J. Fernando

doi:10.1159/000534440

Cited by 3 publications

(4 citation statements)

References 76 publications

(119 reference statements)

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“…This could be explained by the higher rebleeding rate in the subretinal injection group and overall relative undertreatment with postoperative anti-VEGF injections in our study. The late decline of VA highlights the importance of continued anti-VEGF injections to maintain long-term VA and prevention of rebleeding following successful surgical SMH displacement [20,26,27]. The subretinal cocktail injection may increase SMH displacement rate through several mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Martel and Mahmoud proposed subretinal injection of a cocktail solution consisting of tPA, bevacizumab, and filtered air following PPV to improve displacement rate [15], with a complete foveal displacement rate ranges from 92 to 100% [16][17][18][19]. There are, however, scarce data on the safety and efficacy of this technique in small-sized SMH [20].…”

Section: Introductionmentioning

confidence: 99%

“…To date, there is no consensus on the optimal surgical technique to displace SMH as there is a paucity of studies comparing different surgical techniques [20]. Moreover, most of these studies did not include eyes with PCV and extensive SMH that extends beyond temporal vascular arcade [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Displacement of Submacular Hemorrhage Using Subretinal Cocktail Injection versus Pneumatic Displacement: A Real-World Comparative Study

Szeto,

Tsang,

Mohamed

et al. 2024

Ophthalmologica

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Introduction: The objective of this study was to compare the outcome of submacular hemorrhage (SMH) displacement using pneumatic displacement with intravitreal expansile gas versus pars plana vitrectomy (PPV) with subretinal injection of tissue plasminogen activator (tPA), anti-vascular endothelial growth factor (VEGF) agent, and air as primary surgery. Methods: Retrospective interventional case series of 63 patients who underwent surgical displacement of SMH secondary to neovascular age-related macular degeneration (nAMD) or polypoidal choroidal vasculopathy (PCV) from May 1, 2015, to October 31, 2022. Medical records were reviewed for diagnosis, logMAR visual acuity (VA), central subfield thickness (CST), and postoperative displacement rates and complications up to 12 months after operation. Results: The diagnosis was nAMD in 24 (38.1%) and PCV in 39 (61.9%) eyes. There were 40 (63.5%) eyes in the pneumatic displacement group (38 received C3F8, 2 received SF6) and 23 (36.5%) eyes in the subretinal cocktail injection. Mean baseline VA was 1.46 and 1.62, respectively (p = 0.404). The subretinal injection group had more extensive SMH (p = 0.005), thicker CST (1,006.6 μm vs. 780.2 μm, p = 0.012), and longer interval between symptom and operation (10.65 vs. 5.53 days, p < 0.001). The mean postoperative VA at 6 months was 0.67 and 0.91 (p = 0.180) for pneumatic displacement and subretinal injection groups, respectively, though VA was significantly better in the pneumatic group at 12-month visit (0.64 vs. 1.03, p = 0.040). At least 10 mean change in VA were >10 letters gain in both groups up to 12 months. Postoperative CST reduction was greater (625.1 μm vs. 326.5 μm, p = 0.008) and complete foveal displacement (87.0% vs. 37.5%), p < 0.001, odds ratio [OR] = 11.1) and displacement to arcade or beyond (52.5% vs. 17.5%, p = 0.009, OR = 5.15) were more frequent in the subretinal injection group. Two patients with failed pneumatic displacement were successfully treated with subretinal cocktail injection as a second operation. Conclusion: Surgical displacement of SMH leads to clinically meaningful improvement in VA. PPV with subretinal cocktail injection is more effective than pneumatic displacement in displacing SMH with similar safety profile despite longer interval before operation, higher CST, and more extensive SMH at baseline. Retinal surgeons could consider this novel technique in cases with thick and extensive SMH or as a rescue secondary operation in selected cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Displacement of Submacular Hemorrhage Using Subretinal Cocktail Injection versus Pneumatic Displacement: A Real-World Comparative Study

Szeto,

Tsang,

Mohamed

et al. 2024

Ophthalmologica

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“…In addition, the treatment is troublesome for patients as it includes repeated injections into one eye or both eyes and constitutes a serious financial burden for the patients. An alternative for resistance to or intolerance of anti-VEGFA treatment is photodynamic therapy, which may be applied along with the anti-VEGFA treatment [5,6].…”

Section: Introductionmentioning

confidence: 99%

A New Generation of Gene Therapies as the Future of Wet AMD Treatment

Blasiak,

Pawlowska,

Ciupińska

et al. 2024

IJMS

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Age-related macular degeneration (AMD) is an eye disease and the most common cause of vision loss in the Western World. In its advanced stage, AMD occurs in two clinically distinguished forms, dry and wet, but only wet AMD is treatable. However, the treatment based on repeated injections with vascular endothelial growth factor A (VEGFA) antagonists may at best stop the disease progression and prevent or delay vision loss but without an improvement of visual dysfunction. Moreover, it is a serious mental and financial burden for patients and may be linked with some complications. The recent first success of intravitreal gene therapy with ADVM-022, which transformed retinal cells to continuous production of aflibercept, a VEGF antagonist, after a single injection, has opened a revolutionary perspective in wet AMD treatment. Promising results obtained so far in other ongoing clinical trials support this perspective. In this narrative/hypothesis review, we present basic information on wet AMD pathogenesis and treatment, the concept of gene therapy in retinal diseases, update evidence on completed and ongoing clinical trials with gene therapy for wet AMD, and perspectives on the progress to the clinic of “one and done” therapy for wet AMD to replace a lifetime of injections. Gene editing targeting the VEGFA gene is also presented as another gene therapy strategy to improve wet AMD management.

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New Generation of Gene Therapies as the Future of Wet AMD Treatment

Blasiak,

Pawlowska,

Ciupinska

et al. 2024

Preprint

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Age-related macular degeneration (AMD) is an eye disease and the most common cause of vision loss in the Western World. In its advanced stage, AMD occurs in two clinically distinguished forms: dry and wet, but only wet AMD is treatable. However, the treatment based on repeated injections with vascular endothelial growth factor A (VEGFA) antagonists may at best stop the disease progression and prevent or delay vision loss but without an improvement of visual dysfunction. Moreover, it is a serious mental and financial burden for patients and may be linked with some complications. The recent first success of intravitreal gene therapy with ADVM-022, which transformed retinal cells to continuous production of aflibercept, a VEGF antagonist, after a single injection, has opened a revolutionary perspective in wet AMD treatment. Promising results obtained so far in other ongoing clinical trials support this perspective. In this narrative/hypothesis review, we present basic information on wet AMD pathogenesis and treatment, the idea of gene therapy in retinal diseases, update evidence on completed and ongoing clinical trials with gene therapy for wet AMD, and perspectives on the road to the clinic of “one and done” therapy for wet AMD to replace a lifetime of injections. Gene editing targeting the VEGFA gene is also presented as another gene therapy strategy to improve wet AMD management.

show abstract

Current Management of Subretinal Hemorrhage in Neovascular Age-Related Macular Degeneration

Cited by 3 publications

References 76 publications

Displacement of Submacular Hemorrhage Using Subretinal Cocktail Injection versus Pneumatic Displacement: A Real-World Comparative Study

Displacement of Submacular Hemorrhage Using Subretinal Cocktail Injection versus Pneumatic Displacement: A Real-World Comparative Study

A New Generation of Gene Therapies as the Future of Wet AMD Treatment

New Generation of Gene Therapies as the Future of Wet AMD Treatment

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