Tissue Plasminogen Activator for Subfoveal Hemorrhage Due to Age-Related Macular Degeneration

Fassbender, Janelle M.; Sherman, Mark; Barr, Charles C.; Schaal, Shlomit

doi:10.1097/iae.0000000000001030

Cited by 30 publications

(29 citation statements)

References 40 publications

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“…30 Studies by Fujikawa et al, Mizutani et al, and Fassbender et al looked at the effects of tPA in patients with submacular hemorrhage, and results were mixed with it not making a difference, increasing the chance of a rebleed, or helping with visual outcome respectively. 21,22,29 Our study was unique in that patients in the pneumatic ± tPA group received their pneumatic displacement and intravitreal tPA in a staged process so the effects of each step could be observed. Most patients in the pneumatic ± tPA group in our study returned after intravitreal injection of C3F8 and had not yet had sufficient displacement of their hemorrhage (16 of 18 patients).…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Versus Subretinal Tissue Plasminogen Activator Injection for Submacular Hemorrhage

Bell¹,

Shulman²,

Swan³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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Section: Discussionmentioning

confidence: 99%

Intravitreal Versus Subretinal Tissue Plasminogen Activator Injection for Submacular Hemorrhage

Bell¹,

Shulman²,

Swan³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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“…Limited studies have reported the efficacy of a vitrectomy and subretinal tPA for SMH [ 5 ]. Fassbender et al reported that the PPV/tPA/SF 6 showed a better outcome than PD only (changes of mean BCVA were −0.90 vs. +0.10 logMAR units) [ 22 ]. Treumer et al treated SMH patients with a PPV, a subretinal tPA and anti-VEGF [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Management of a Submacular Hemorrhage Secondary to Age-Related Macular Degeneration: A Comparison of Three Treatment Modalities

Jeong

Park

Sagong

2020

JCM

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This paper aims to compare the effects of three treatment modalities for a submacular hemorrhage (SMH) secondary to exudative age-related macular degeneration (AMD). Seventy-seven patients with an SMH were divided into three groups: small-sized (optic disc diameter (ODD) ≥ 1 to < 4), medium-sized (ODD ≥ 4 within the temporal arcade) and large-sized (ODD ≥ 4, exceeding the temporal arcade). Patients received anti-vascular endothelial growth factor (anti-VEGF) monotherapy, pneumatic displacement (PD) with anti-VEGF or a vitrectomy with a subretinal tissue plasminogen activator (tPA) and gas tamponade based on the surgeon’s discretion. The functional and anatomical outcomes were evaluated. Among the 77 eyes, 45 eyes had a small-sized, 21 eyes had a medium-sized and 11 eyes had a large-sized SMH. In the small-sized group, all treatment modalities showed a gradual best-corrected visual acuity (BCVA) improvement with high hemorrhagic regression or displacement rates (over 75%). In the medium-sized group, PD and surgery were associated with better BCVA with more displacement than anti-VEGF monotherapy (67% and 83%, respectively, vs. 33%). In the large-sized group, surgery showed a better visual improvement with a higher displacement rate than PD (86% vs. 25%). Our findings demonstrated that visual improvement can be expected through appropriate treatment strategy regardless of the SMH size. In cases with a larger SMH, invasive techniques including PD or surgery were more advantageous than anti-VEGF monotherapy.

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“…At the same time, intravitreal injection of tPA and gas has been found to be safe and effective in clinical trials in terms of displacing submacular clots and improving visual acuity [17,[37][38][39]. 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.…”

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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Tissue Plasminogen Activator for Subfoveal Hemorrhage Due to Age-Related Macular Degeneration

Cited by 30 publications

References 40 publications

Intravitreal Versus Subretinal Tissue Plasminogen Activator Injection for Submacular Hemorrhage

Intravitreal Versus Subretinal Tissue Plasminogen Activator Injection for Submacular Hemorrhage

Management of a Submacular Hemorrhage Secondary to Age-Related Macular Degeneration: A Comparison of Three Treatment Modalities

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

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