Pneumatic displacement and intravitreal bevacizumab: A new approach for management of submacular hemorrhage in choroidal neovascular membrane

Chawla, Suraj; Misra, Vishal; Khemchandani, Mohit

doi:10.4103/0301-4738.45511

Cited by 16 publications

(18 citation statements)

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“…in four cases where they injected intravitreal bevacizumab, 0.05 ml, along with 0.5 ml of SF6 through the pars plana into the vitreous cavity for SMH secondary to choroidal neovascularisation (CNV). [26]…”

Section: Discussionmentioning

confidence: 99%

Submacular hemorrhage: A study amongst Indian eyes

Rishi

Gopal

Rishi

et al. 2012

Indian J Ophthalmol

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Aim:To evaluate the management outcomes amongst various treatment modalities for submacular hemorrhage (SMH) in Indian subjects.Settings and Design:Retrospective, single-center study.Materials and Methods:Patients presenting with SMH between 1999 and 2006 were included. Treatment modalities included: vitrectomy with subretinal recombinant tissue plasminogen activator (r-tPA) assisted SMH evacuation (group 1, n = 14); pneumatic displacement with intravitreal r-tPA and gas (group 2, n = 25); and pneumatic displacement with intraocular gas (group 3, n = 7). Favorable anatomical outcome was defined as complete displacement of SMH from fovea and favorable functional outcome was defined as a gain of >2 Snellen lines from the baseline. Kruskal–Wallis, analysis of variance (ANOVA), and Chi-square tests were used to compare the three groups, while Mann–Whitney and independent t-test were used to evaluate the influence of duration and size of SMH on outcomes.Results:There was no difference amongst groups in terms of favorable anatomical (P = 0.121) or functional outcomes (P = 0.611). Eyes with median duration of SMH less than 7.5 days had a significantly higher probability of achieving favorable anatomical outcome compared to eyes with SMH >14.5 days (P = 0.042). However, duration of SMH did not influence functional outcome (P = 0.595). Similarly, size of SMH did not affect anatomical (P = 0.578) or functional (P = 0.381) outcome. Median follow-up was 31.5, 6.5, and 2.5 months in the three groups, respectively.Conclusions:Co- existing posterior segment conditions and duration of SMH may influence the choice of treatment modality and treatment outcomes. Pneumatic displacement with r-tPA and r-tPA assisted vitrectomy appear to be favorable options for the management of SMH.

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Section: Discussionmentioning

confidence: 99%

Submacular hemorrhage: A study amongst Indian eyes

Rishi

Gopal

Rishi

et al. 2012

Indian J Ophthalmol

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“…In addition, there have been concerns about the toxicity of rTPA to the neural retina, and this has led us to stop using rTPA for the treatment of SMH 20,21. Recently, two case series reported successful treatment of SMH using a combination of IVB and PD without rTPA 22,23…”

Section: Introductionmentioning

confidence: 99%

Pneumatic displacement with intravitreal bevacizumab for massive submacular hemorrhage due to polypoidal choroidal vasculopathy

Kitahashi¹,

Baba²,

Sakurai³

et al. 2014

OPTH

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BackgroundThe purpose of this study was to compare the effectiveness of pneumatic displacement combined with intravitreal bevacizumab (IVB) with that of pneumatic displacement (PD) alone to treat massive submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV).MethodsThirty-two eyes of 32 patients with massive SMH secondary to PCV were studied. Twenty-two eyes were treated with a combination of PD and 1.25 mg of intravitreal bevacizumab (PD + IVB group), and ten eyes with pneumatic displacement alone (PD group).ResultsPretreatment, the differences in best-corrected visual acuity and size of the SMH between the two groups were not significant (P=0.59 and P=0.72, respectively). Complete displacement of the hemorrhage from under the fovea was achieved in 19 of 22 eyes (86.4%) in the PD + IVB group and in five of ten eyes (50%) in the PD group. The best-corrected visual acuity in the PD + IVB group was significantly better than that in the PD group at one, 3, and 6 months after treatment (P<0.001, P<0.001, and P<0.001, respectively). Improvement in best-corrected visual acuity by >0.3 logMAR units was obtained in 18 eyes (81.8%) in the PD + IVB group and two eyes (20%) in the PD group (P<0.001). The number of eyes that required additional treatments was significantly fewer in the PD + IVB group than in the PD group (P=0.0001).ConclusionThe combination of PD and IVB may be a better therapeutic procedure for eyes with massive SMH due to PCV in the short term because of the better visual outcome and less need for additional treatments.

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“…However, recent evidence showing that both treatments are effective for submacular hemorrhage secondary to exudative AMD. [23][24][25][26][27][28] In addition, the efficacy of additional pneumatic displacement may be minimal in anti-VEGF therapy for submacular hemorrhage secondary to exudative AMD. 29 Thus, the influence of combined treatment in our patients may not have been significant.…”

Section: Discussionmentioning

confidence: 98%