Optical Coherence Tomography Findings and Surgical Outcomes of Tissue Plasminogen Activator–assisted Vitrectomy for Submacular Hemorrhage Secondary to Age-Related Macular Degeneration

Hirashima, Takafumi; Moriya, Takeshi; Bun, Toshitaka; Utsumi, Takao; Hirose, Miou; Oh, Hideyasu

doi:10.1097/iae.0000000000000574

Cited by 16 publications

(16 citation statements)

References 31 publications

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“…As this was only noted in univariate analysis, we suggest further study is needed and that IVB combined with PD may have a role in treating patients in the outpatient clinic. In contrast to previous studies suggesting the integrity of the IS/OS line and SMH height as good indicators for long‐term visual outcome, our study found no significance …”

Section: Discussioncontrasting

confidence: 99%

“…In contrast to previous studies suggesting the integrity of the IS/OS line and SMH height as good indicators for long-term visual outcome, our study found no significance. 20 Although complications such as sudden retinal detachment and breakthrough VH in nonvitrectomized eyes receiving PD have been previously reported, 19 there were no occurrences of retinal detachment or other significant complications associated with the use of PD in our study.…”

Section: Discussionmentioning

confidence: 44%

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Long‐term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy

Kang

Byeon

et al. 2018

Clinical Exper Ophthalmology

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 44%

Long‐term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy

Kang

Byeon

et al. 2018

Clinical Exper Ophthalmology

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“…Hirashima et al . [33] recently reported that there was a significant relationship between a better postoperative BCVA and SMH height <400 milimicron. This report is the only one to evaluate vertical height and OCT findings of SMHs.…”

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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“…[222223224225] The visual outcome depends on presenting BCVA, the duration, thickness, extent of hemorrhage, thinner neurosensory retinal thickness at presentation, and disruption of ellipsoid zone. [226227228229230231] The aim of treatment is to displace the hemorrhage before irreversible damage to photoreceptors occurs. SMH secondary to PCV is treated with pneumatic displacement or vitrectomy with pneumatic displacement.…”

Section: Treatment Of Submacular Hemorrhagementioning

confidence: 99%

Polypoidal choroidal vasculopathy: An update on current management and review of literature

Palkar

Khetan

2019

Taiwan J Ophthalmol

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Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research.

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Optical Coherence Tomography Findings and Surgical Outcomes of Tissue Plasminogen Activator–assisted Vitrectomy for Submacular Hemorrhage Secondary to Age-Related Macular Degeneration

Abstract: The preoperative presence of detectable ellipsoid layers and a lower height of SMH may predict good visual prognosis. In contrast, no specific features of pigment epithelial detachment correlated with postoperative best-corrected visual acuity.

Cited by 16 publications

References 31 publications

Long‐term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy

Long‐term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy

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

Polypoidal choroidal vasculopathy: An update on current management and review of literature

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