Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration

Early treatment of acute submacular haemorrhage secondary to wet AMD using intravitreal tissue plasminogen activator, C3F8, and an anti-VEGF agent

“…[14][15][16][17] This may be because of earlier treatment in our study as duration of symptoms in other series ranged from 6 days 17 to 11.25 days. 15 A further factor may be that patients had poorer baseline visual acuity in our case series, with more potential for visual gain.…”

“…One previous study only included patients with small macular haemorrhages of one to three disc diameters in size, 14 and others only included large haemorrhages of greater than four disc diameters. 15,17 Therefore, as well as documenting visual gains using this approach, our study suggests that triple therapy could be used to treat all patients who present with acute submacular haemorrhage irrespective of their presenting visual acuity or size of haemorrhage. A larger study is required to establish this further.…”

“…The central retinal artery was visualised by indirect ophthalmoscopy immediately following drug delivery to ensure pulsation and good flow was seen. Furthermore, the expansile gas used in our case series was C 3 F 8 that requires a smaller volume to be injected (0.3 ml) than the alternative SF6 (∼0.4 ml, used in the majority of previous case series using triple therapy [14][15][16] ). Subsequently, none of our patients had complications of retinal vascular occlusion and only one patient had transiently elevated IOP treated with topical therapy.…”

“…[14][15][16][17] In these series, mean duration of symptoms ranged from 6 days 17 to 11.25 days. 16 Furthermore, one study only included patients with small submacular haemorrhages of one to three disc diameters, 14 whereas another study only included patients with more extensive haemorrhage of between 4 and 10 disc diameters.…”

“…16 Furthermore, one study only included patients with small submacular haemorrhages of one to three disc diameters, 14 whereas another study only included patients with more extensive haemorrhage of between 4 and 10 disc diameters. 15 In view of the short timescale within which photoreceptor damage occurs, we assessed whether prompt treatment of patients presenting with subfoveal macular haemorrhage of any presenting size was effective in improving visual outcomes. All patients were treated with intravitreal injection of tPA and C 3 F 8 to lyse and displace haemorrhage along with an anti-VEGF agent to address underlying pathology.…”