Efficacy of Vitrectomy Combined with Subretinal rtPA Injection with Gas or Air Tamponade

Abstract

Functional and anatomical outcome after vitrectomy with rtPA combined with gas or air tamponade. Retrospective analysis of pseudophakic patients treated with subretinal rtPA and gas or air tamponade. The primary endpoint was displacement of haemorrhage six months after surgery. The secondary endpoints were visual acuity (BCVA), haemorrhage diameter (MHD) and central macular thickness (CMT), as measured by SD-OCT. 53 of 85 eyes were pseudophakic. 27 of these eyes were treated with air tamponade and 26 with gas tamponade. For patients with air tamponade, the mean BCVA improved from 20/530 to 20/355 (p = 0.01). MHD and CMT decreased from 6386 ± 2281 µm to 3805 ± 2397 µm (p < 0.001) and 895 ± 592 µm to 532 ± 386 µm (p < 0.001), respectively. For patients with gas tamponade, the mean BCVA improved only slightly, from 20/471 to 20/394 (p = 0.17). MHD and CMT exhibited statistically significant decreases from 6759 ± 1773 µm to 3525 ± 1548 µm (p < 0.001) and 1089 ± 587 µm to 537 ± 251 µm (p < 0.001), respectively. Vitrectomy with subretinal rtPA injection has strong functional and anatomical effects on submacular haemorrhages with both gas and air tamponade.

Combined Administration of Preoperative Intravitreal and Intraoperative Subretinal Recombinant Tissue Plasminogen Activator in Acute Hemorrhagic Age-related Macular Degeneration

“…This procedure reduces the risk of iatrogenic RD and PVR and causes less damage to the photoreceptors during clot removal [24]. When further combined with gas, vitrectomy and subretinal TPA administration avoids the mechanical removal of the clot [9].…”

“…rTPA dissolves the SMH and the gas displaces the SMH by either steam roller action or by gravity to a region where the SMH can be reabsorbed and the damage caused by SMH can be reduced [8]. It is been also shown that an air tamponade is as effective as gas, indicating that the duration of blood displacement is not a key factor [9].…”

Comparison between different techniques for treatment of sub macular haemorrhage due to Age Related Macular Degeneration

“…In this retrospective case series study group 2 we used 20% sulphur hexafluoride as a tamponade and added subretinal air as pneumatic subretinal displacement of the SMH in the subgroup 2A. Waizel M. et al in his retrospective analysis of 85 pseudophakic patients had undergone PPV +subretinal tPA and air or gas tamponade with 64.1% complete displacement of SMH away from fovea, highlighted that patients who had air as a tamponade achieved final visual acuity better than others who had gas tamponade either SF6 or C2F6 despite of similar anatomical outcome in the two groups 11 . The displacement rate is 100% in our series probably due to early intervention in all cases.…”

“…Sub foveal large haemorrhages carries poor prognosis 3 . A few surgical techniques were described to treat SMH 4,5,6,7,8,9,10,11,12,13 . In this study we analysed the outcome of two commonly used methods;…”

Comparison between different techniques for treatment of submacular haemorrhage due to Age-Related Macular Degeneration

“…Sub foveal large haemorrhages carries poor prognosis 3 . A few surgical techniques were described to treat SMH 4,5,6,7,8,9,10,11,12,13 . In this study we analysed the outcome of two commonly used methods; Intravitreal gas and TPA versus PPV, Subretinal TPA and gas.…”