Efficacy of Vitrectomy Combined with Subretinal Recombinant Tissue Plasminogen Activator for Subretinal versus Subpigment Epithelial versus Combined Hemorrhages

Abstract

Background: The aim of this study was to compare the outcomes after subretinal recombinant tissue plasminogen activator (rtPA) treatment for subretinal hemorrhages (SRH), subpigment epithelial hemorrhages (SPH), and combined subretinal and subpigment epithelial hemorrhages (CH). Methods: An observational analysis of patients treated with subretinal rtPA was performed. The primary endpoint was the assessment of visual improvement (best-corrected visual acuity, BCVA) after surgery. Secondary endpoints were evaluation of the maximal hemorrhage diameter (MHD) and central macular thickness (CMT) measured by spectral domain optical coherence tomography. Results: From a total of 83 eyes included in the study, 19 eyes showed SRH, 11 eyes SPH, and 53 eyes CH. For SRH and CH, the mean BCVA, MHD, and CMT improved significantly (p < 0.05). For patients with SPH, both the mean MHD and CMT decreased significantly (p < 0.05), whereas the mean BCVA improved only slightly after surgery (p = 0.28). Conclusion: Vitrectomy combined with subretinal rtPA injection and gas or air tamponade has a strong functional and anatomical effect on both SRH and CH and also seems to slightly improve the anatomical outcome in SPH.

Structural and Functional Outcome of Vitrectomy Combined with Subretinal Recombinant Tissue Plasminogen Activator for Isolated Subpigment Epithelial Hemorrhages

“…For any manipulation below the retinal pigment epithelium, there must be considerations about a potential benefit against the risk of provoking a RIP. Our study results allow for a clinical presurgery assessment of the underlying case, based on its anatomical characteristics [2] . However, the case of Fotis et al [1] is important, since it strikingly demonstrates the possibility of a SPH displacement with subretinal rtPA treatment.…”

“…We are very grateful to Fotis et al [1] for their interest in our recently published study [2] that presents the structural and functional outcome after pars plana vitrectomy combined with subretinal recombinant tissue plasminogen activator (rtPA) treatment for isolated subretinal, subpigment epithelial (SPH), and combined hemorrhages. Here, we would like to respond to the questions that were raised by the authors:…”

Anatomical and Functional Outcome of Pars Plana Vitrectomy and Subretinal Recombinant Tissue Plasminogen Activator for a Macular Subpigment Epithelial Haemorrhage

“…They concluded that vitrectomy combined with subretinal recombinant tissue plasminogen activator (rtPA) injection and gas or air tamponade has a strong functional and anatomical effect on both subneuroretinal haemorrhage (SRH) and combined subneuroretinal and sub-retinal pigment epithelial (RPE) haemorrhage (CH) and also seems to slightly improve the anatomical outcome in subpigment epithelial haemorrhage (SPH) [1] .…”

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

“…This method finally resulted in better functional outcome (Heriot WJ 1996, Paper presented at the American Academy of Ophthalmology Annual Vitreoretinal Update in Chicago, IL). Since then, more invasive methods of rtPA-assisted hemorrhage displacement during vitrectomy have been described [10][11][12][13]. Further studies showed that additive anti-VEGF treatment could help to prevent recurrence of submacular hemorrhage [14,15].…”

“…Further studies showed that additive anti-VEGF treatment could help to prevent recurrence of submacular hemorrhage [14,15]. Although intravitreal rtPA seems to be effective the recent trend has been toward the subretinal administration of rtPA during vitrectomy combined with either gas or air tamponade since it has been proved to be a promising combination [4,13,16].…”