Surgical management of submacular hemorrhage due to n-AMD: a comparison of three surgical methods

Abstract

Background: To compare and assess the efficacy of three surgical methods for the treatment of acute submacular hemorrhage (ASH): pneumatic displacement with C2F6, in combination with intravitreal injection of bevacizumab and rtPA, pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and subretinal injection of recombinant tissue plasminogen activator (rtPA), pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and intravitreal injection of recombinant tissue plasminogen activator (rtPA). Methods: The study included 85 patients with ASH. In the group without PPV (A), patients were treated with intravitreal injection of C2F6, bevacizumab and rtPA. In the second and third group, patients underwent a PPV, intravitreal injection of bevacizumab, pneumatic displacement with C2F6 and a subretinal (B) or intravitreal (C) injection of recombinant tissue plasminogen activator (rt PA). Results: In group A, mean BCVA increased from preop logMAR 1.41 to 1.05, in group B from 1.46 to 1.28 and in group C from 1.63 to 1.33. In group A, CFT changed from 764 ± 340 μm at time point 0 to 246 ± 153 μm at time point 1, in group B from 987 ± 441 μm to 294 ± 166 μm and in group C from 642 ± 322 μm to 418 ± 364 μm. Patients had an average of 5 injections after surgery. Conclusion: Our study demonstrates that the three methods are equally effective in improving the morphology and the BCVA of patients with ASH.

Subretinal Injection Techniques for Retinal Disease: A Review

“…Nevertheless, in these cases it has been proven that long-term vision may depend on the underlying disease. Therefore, potential risks and benefits must be carefully taken into account before opting for this treatment as some research has shown no differences between subretinal and conventional vitrectomy approaches [ 50 ].…”

Der Intraokulardruck nach Netzhauteingriffen

“…In this case, iridectomy should be performed. This should be carried out from an inferior position, as silicone oil rises upwards 6 . In aphakic patients who receive a silicone oil tamponade, an iridotomy/iridectomy should be performed prophylactically pre- or intraoperatively.…”

“…In diesem Falle sollte eine Iridektomie durchgeführt werden. Dabei sollte diese inferior erfolgen, da Silikonöl nach oben steigt [6]. Bei aphaken Patienten, die eine Silikonöltamponade erhalten, sollte eine Iridotomie/Iridektomie prophylaktisch prä-oder intraoperativ erfolgen.…”

Role of intravitreal brolucizumab with intravitreal rtPA and pneumatic displacement for submacular hemorrhage: A case series

“…These include a combination of modalities such as intravitreal gas injection, intravitreal or subretinal recombinant tissue plasminogen activator (rtPA), anti-VEGF injection, and pars plana vitrectomy (PPV). 6 Amongst the various anti-VEGF agents currently available, bevacizumab (AVASTIN, Genentech, Inc.,), ranibizumab (Lucentis®; Genentech, S. San Francisco, CA/Roche, Basel, Switzerland), and aflibercept (Eylea®, Regeneron, Tarrytown, NY) have been successfully employed for the management of SMH. 7 , 8 Brolucizumab (Beovu®; Novartis, Basel, Switzerland), the most recent anti-VEGF agent, received the US Food and Drug Administration (FDA) approval for nAMD in 2019.…”