Management of Thick Submacular Hemorrhage With Subretinal Tissue Plasminogen Activator and Pneumatic Displacement for Age-Related Macular Degeneration

Chang, Woo Hyok; Garg, Sunir J.; Maturi, Raj K.; Hsu, Jason; Sivalingam, Arunan; Gupta, Shivali; Regillo, Carl D.; Ho, Allen C.

doi:10.1016/j.ajo.2014.02.007

Cited by 89 publications

(80 citation statements)

References 35 publications

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“…However, the results of published studies are inconsistent, and the role of coagulation factors in the development of RVO remains unclear [24]. It is well recognized that submacular hemorrhage from neovascular age-related macular degeneration (AMD) or retinal artery macroaneuryms (RAMs) often causes severe visual impairment [25, 26]. Previous experimental studies have suggested several mechanisms by which subretinal hemorrhage damages the overlying photoreceptors, such as clot retraction, iron toxicity (hemosiderosis), induction of fibrosis, and blockage of nutrient diffusion from the choroidal circulation [27].…”

Section: Pathogenesismentioning

confidence: 99%

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

Paulus

Shuai

et al. 2017

Journal of Ophthalmology

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For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.

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Section: Pathogenesismentioning

confidence: 99%

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

Paulus

Shuai

et al. 2017

Journal of Ophthalmology

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“…[31] using vitrectomy, the average duration of SMHs was 16 days (range, 1–60 days). Statistically significant visual improvement was reported after surgery in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[14272829303132] Postoperative recurrence of SMH may not be associated with vitrectomy combined with r-tPA because 40% of patients with AMD treated and followed after anti-VEGF therapy developed SMH in the natural course of the disease. [16] We observed recurrence of SMH in 1 patient after surgery.…”

Section: Discussionmentioning

confidence: 99%

Tissue plasminogen activator-assisted vitrectomy for submacular hemorrhage due to age-related macular degeneration

Gök

Karabaş

Aslan

et al. 2017

Indian J Ophthalmol

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Purpose:The purpose of this study was to evaluate the treatment efficacy of vitrectomy combined with subretinal recombinant tissue plasminogen activator (r-tPA) and factors affecting visual improvement in patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (nAMD).Materials and Methods:Medical records of 17 consecutive patients diagnosed with SMH secondary to nAMD were retrospectively reviewed. The initial surgical procedure involved a 23-gauge transconjunctival vitrectomy, subretinal r-tPA application through a self-sealing inferior retinotomy, and sulfur hexafluoride gas for tamponade in all patients. The duration, size, and thickness of the hemorrhage and the pre- and post-operative visual acuity (VA) using a Snellen chart were recorded. VA was converted to logMAR for statistical analysis.Results:The average duration and size of the SMH were 12.8 ± 18.2 days and 8.6 ± 5.3 disc areas, respectively. The mean follow-up time was 16.9 ± 4.7 months. A statistically significant visual improvement was found when comparing initial VA with postoperative best-corrected VA (BCVA) and final BCVA (Wilcoxon rank test, P ≤ 0.01). There was no significant correlation between the size of the hemorrhage and postoperative BCVA and final BCVA (Spearman's rho test). There was no statistically significant correlation between the initial VA and postoperative BCVA and final BCVA (Spearman's rho test). There was no significant correlation between the duration of hemorrhage and postoperative BCVA and final BCVA (Spearman's rho test). The preoperative thickness of hemorrhage (747.5 ± 30 μm) was not correlated with postoperative BCVA or final BCVA (Pearson's test).Conclusions:Vitrectomy combined with subretinal r-tPA injection and gas tamponade is an effective surgical intervention to preserve VA in selected patients with apparent SMH.

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“…Some recent reports [40][41][42] even suggest that intravitreal injection of tPA and gas without vitrectomy may be as effective in reducing blood volume as submacular injection of tPA with vitrectomy. Treatment with intravitreal tPA has also been reported to yield better functional and anatomic outcomes than pneumatic displacement alone [40]. In addition, Ozone et al [43] investigated the antiangiogenic efficacy of intravitreal tPA on experimental laser-induced choroidal neovascularization in mice.…”

Section: Discussionmentioning

confidence: 99%

Retinal Penetration of Intravitreally Injected Tissue Plasminogen Activator: A Rat Model Study

Tal

Dotan²,

Nisgav³

et al. 2017

Ophthalmic Res

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Purpose: To determine whether intravitreal unconjugated tissue plasminogen activator (tPA) (alteplase) can penetrate the intact neural retina and reach the subretinal space in an experimental model. Methods: This study was performed in 24 Sprague-Dawley rats aged 12 weeks. Under general anesthesia, the right eye was injected with either 0.75 μg of 3 μL tPA (14 rats; study group) or saline (10 rats, control group) into the vitreous. Animals were euthanized at 3, 24, and 48 h. The eyes were enucleated, and cryosections were prepared for immunofluorescence staining. Goat anti-tPA antibody was used to detect tPA. Results: In the study group, staining for tPA was detected in the deep retinal layers in all eyes. The staining was deeper and more intense at 3 and 24 h than at 48 h. There was no tPA staining in the retina of eyes injected with saline. Conclusions: This experimental study shows that unconjugated tPA administered into the vitreous is capable of penetrating the deep retinal layers and the subretinal space. These findings suggest that further clinical research is warranted on the benefits of intravitreal tPA in the treatment of submacular hemorrhage.

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Management of Thick Submacular Hemorrhage With Subretinal Tissue Plasminogen Activator and Pneumatic Displacement for Age-Related Macular Degeneration

Cited by 89 publications

References 35 publications

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

Tissue plasminogen activator-assisted vitrectomy for submacular hemorrhage due to age-related macular degeneration

Retinal Penetration of Intravitreally Injected Tissue Plasminogen Activator: A Rat Model Study

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