Retinal sensitivity after displacement of submacular hemorrhage due to polypoidal choroidal vasculopathy: effectiveness and safety of subretinal tissue plasminogen activator

Kimura, Shuhei; Morizane, Yuki; Matoba, Ryo; Hosokawa, Mio; Shiode, Yusuke; Hirano, Masayuki; Toshima, Shinji; Takahashi, Kosuke; Hosogi, Mika; Fujiwara, Atsushi; Shiraga, Fumio

doi:10.1007/s10384-017-0530-0

Cited by 12 publications

(8 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although we focused on injection pressure in the present study, several other factors should be considered with respect to the retinal damage caused by subretinal injection. The first is the volume of the liquid to be injected under the retina, which differs depending on the aim and content of the subretinal injection (tPA [2,4,26], adenovirus vector [5,6,8], cell suspension [27–29], or BSS [9–13]). It has been reported that excessive stretching of the retina by the injected liquid can cause photoreceptor cell death by extension stress [15].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical subretinal injections are used to displace subretinal hemorrhages [1–4], deliver gene therapy for retinal degeneration [5–8], perform macular translocation in patients with age-related macular degeneration [9,10], remove hard foveal exudates [11], and resolve diffuse diabetic macular edema during planned foveal detachment procedures [12,13]. To ensure that visual function is preserved after such procedures, clinicians must not damage the macula, and a safe and reliable technique for subretinal injection must therefore be developed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The influence of subretinal injection pressure on the microstructure of the monkey retina

et al. 2018

Self Cite

View full text Add to dashboard Cite

PurposeTo investigate the influence of subretinal injection pressure on the microstructure of the retina in a monkey model.MethodsAfter vitrectomy, balanced salt solution was injected subretinally into one eye each of four cynomolgus monkeys while controlling the injection pressure. Initially, a pressure of 2 psi was used, and this was gradually increased to determine the minimum required pressure. Subsequent injections were performed at two pressures: minimum (n = 13) and high (n = 6). To compare the influence of these injection pressures on retinal structure, optical coherence tomography (OCT) was performed before surgery and every week afterwards. The monkeys were euthanized and their eyes were enucleated at 1 or 6 weeks after the injections. The eyes were processed for light microscopy and transmission electron microscopy (TEM) as well as for TdT-mediated dUTP nick end labeling.ResultsThe minimum pressure required to perform subretinal injection was 6 psi. After injection at this pressure, both OCT and microscopy showed that the retinal structure was well-preserved throughout the experimental period at all injection sites. Conversely, after injection at high pressure (20 psi) OCT images at all injection sites showed disruption of the ellipsoid zone (EZ) after 1 week. Microscopy indicated damage to the photoreceptor outer segment (OS) and stratification of the retinal pigment epithelium (RPE). After 6 weeks, OCT demonstrated that the EZ had become continuous and TEM confirmed that the OS and RPE had recovered. Photoreceptor apoptosis was absent after subretinal injection at both pressures.ConclusionsThe retinal damage caused by subretinal injection increases depending on pressure, indicating that clinicians should perform subretinal injection at pressures as low as possible to ensure safety.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The influence of subretinal injection pressure on the microstructure of the monkey retina

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…14 Kimura et al reported that the displacement of subretinal hemorrhage by PPV and subretinal injection of tPA with air tamponade can improve the retinal sensitivity and the best-corrected visual acuity (BCVA). 15,16 The overall results including that from a multicenter study showed that PPV combined with a subretinal injection of tPA and air was effective in eyes with a massive subretinal hemorrhage. The results also showed a consistent displacement of the submacular hemorrhage away from the fovea.…”

Section: Introductionmentioning

confidence: 99%

Vitrectomy combined with subretinal injection of tissue plasminogen activator for successful treatment of massive subretinal hemorrhage

Saito-Uchida

Inoue

Koto

et al. 2020

European Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose: To evaluate the outcome of vitrectomy combined with a subretinal injection of tissue plasminogen activator (tPA) to treat a massive subretinal hemorrhage. Methods: The medical records of 11 eyes of 11 patients (seven men, four women, mean age; 74.5 ± 9.6 years) with a massive (>10 disc area) subretinal hemorrhage were reviewed. The patients were treated with vitrectomy combined with a subretinal injection of tPA with or without external drainage. Results: The mean baseline visual acuity was 2.10 ± 0.45 logarithm of the minimum angle of resolution (logMAR) units. The hemorrhage was externalized in three eyes due to bullous hemorrhagic retinal detachment. The subretinal hemorrhage was displaced away from the fovea in 10 eyes (91%) and reduced in one eye. Retinal reattachment was achieved in all eyes however reoperations were needed in five eyes (45%) among the eight eyes (73%) with recurrent vitreous and/or subretinal hemorrhages. The postoperative vision at 3 months was significantly improved to 1.32 ± 0.65 logMAR units ( p = 0.0076). The vision in the two eyes without postoperative subretinal hyperreflective material at the fovea recovered to 0.4 logMAR units but none of the nine eyes with the foveal subretinal hyperreflective material had vision better than 0.1 logMAR units. Conclusion: Vitrectomy with subretinal injection of tPA with or without external drainage of the subretinal hemorrhage was effective in treating massive subretinal hemorrhages.

show abstract

“…Macular sensitivity in retinal diseases is usually evaluated using static perimetry tests within the central 10° and more recently with the use of microperimetry devices such as the Microperimetry-3 (MP-3; Nidek Technologies, Albignasego, Italy) and the Macular Integrity Assessment (MAIA; CenterVue, Padua, Italy) [3–9]. These microperimetry devices have wide dynamic ranges comparable to that of a Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Dublin, CA).…”

Section: Introductionmentioning

confidence: 99%

Direct comparison of retinal structure and function in retinitis pigmentosa by co-registering microperimetry and optical coherence tomography

et al. 2019

View full text Add to dashboard Cite

PurposeTo evaluate the retinal structure-function relationships in the macula of retinitis pigmentosa (RP) patients by comparing microperimetry-3 (MP-3) images with co-registered optical coherence tomography (OCT) images.MethodsThirty patients with typical RP were recruited from our hospital. The maculae of patients were examined with MP-3 and OCT. The retinal sensitivity was measured by MP-3 at 40 testing points arranged concentrically in a 16° diameter of the central retina, and we divided the 40 points into four zones according to degree from the fovea (2°, 4°, 6°, and 8°). We analyzed the correlation coefficients between the retinal sensitivity and the total retinal thickness (TRT), the length from the inner limiting membrane to the retinal pigment epithelium (RPE), and between the retinal sensitivity and the outer retinal thickness (ORT), the length from the outer plexiform layer to the RPE at each stimulus point.ResultsTRT showed moderate correlations with the retinal sensitivity at 2° (median ρ = 0.59 interquartile range (IQR) [0.38–0.72]), 4° (ρ = 0.59 [0.55–0.68]) and 6° (ρ = 0.60 [0.54–0.63]), and TRT was weakly-to-moderately related to the retinal sensitivity at 8° (ρ = 0.27 [0.19–0.48]). ORT exhibited strong correlations at 2° (ρ = 0.72 [0.60–0.81]), 4° (ρ = 0.71 [0.75–0.67]) and 6° (ρ = 0.70 [0.54–0.74]), and a weak-to-moderate correlations at 8° (ρ = 0.34 [0.29–0.53]). ORT was more strongly correlated with the retinal sensitivity compared to TRT (p = 0.018).ConclusionORT, rather than TRT, within 6° eccentricity was strongly correlated with the retinal sensitivity, suggesting that measuring ORT in those areas will help evaluate the macular status and progression in RP.

show abstract

Retinal sensitivity after displacement of submacular hemorrhage due to polypoidal choroidal vasculopathy: effectiveness and safety of subretinal tissue plasminogen activator

Abstract: Displacement of SMH effectively improves retinal sensitivity as well as BCVA.

Cited by 12 publications

References 35 publications

The influence of subretinal injection pressure on the microstructure of the monkey retina

The influence of subretinal injection pressure on the microstructure of the monkey retina

Vitrectomy combined with subretinal injection of tissue plasminogen activator for successful treatment of massive subretinal hemorrhage

Direct comparison of retinal structure and function in retinitis pigmentosa by co-registering microperimetry and optical coherence tomography

Contact Info

Product

Resources

About