Management of submacular hemorrhage by tissue plasminogen activator and SF6 gas injection

Meier, Petra; Zeumer, C; Jochmann, Claudia; Wiedemann, Peter

doi:10.1007/s003470050467

Cited by 15 publications

(9 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vitreous hemorrhage rate ranged from 0–45% in group 1 [25,27,28,29,30,31,32,33,34,35,37,38,40,41,42,43],and 0–43% in group 2 [11,12,13,24,44,45 ](table 3). …”

Section: Resultsmentioning

confidence: 99%

“…One study employed intravitreal rtPA with and without intravitreal gas injection [28]. Fifteen studies reported intravitreal injection of both rtPA and gas [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]; one of these 15 studies incorporated the results of its own, older article [32,39]. Five studies reported intravitreal rtPA and intravitreal anti-VEGF agents and gas injections [11,12,13,44,45].…”

Section: Resultsmentioning

confidence: 99%

“…The less invasive group had a range of 50–100% complete displacement rate (n = 467) [11,12,13,24,25,29,30,31,32,33,34,35,37,38,40,42,44,45] while the most invasive group had a range of 53–100% displacement rate (n = 194, including 28 REH patients) [5,6,7,8,9,10,14,46]. The range of recurrence of submacular hemorrhage was 0–27% in both the less invasive and most invasive group.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Literature Review of Recombinant Tissue Plasminogen Activator Used for Recent-Onset Submacular Hemorrhage Displacement in Age-Related Macular Degeneration

Zeeburg

Meurs

2012

Ophthalmologica

View full text Add to dashboard Cite

Aims: To review and discuss the literature on recombinant tissue plasminogen activator (rtPA) for the treatment of a recent-onset submacular hemorrhage in patients with age-related macular degeneration. Methods: The administration technique of rtPA, the use of additional gas and vascular endothelial growth factor inhibitors (anti-VEGF), and the displacement rate of submacular hemorrhage and complications were noted from published reports, and a case series from the Rotterdam Eye Hospital (REH). Results: 38 studies with a total of 1,185 patients (1,176 eyes), and 28 patients from the REH were analyzed. Several methods for rtPA administration are available, which can be divided into two groups: submacular rtPA administration with vitrectomy; or intravitreal rtPA administration without vitrectomy. In both groups, the administration of gas and/or anti-VEGF agents could be additional. There appears to be no clear difference in complete displacement or complication rate between the more or the less invasive treatment groups. Conclusion: Although intravitreal injection of rtPA and gas only was reported to be as effective as subretinal rtPA with vitrectomy and gas, recent studies tend to use vitrectomy. These data underscore the need for a randomized controlled trial to choose the most effective and safe method of rtPA administration.

show abstract

“…Vitreous hemorrhage rate ranged from 0–45% in group 1 [25,27,28,29,30,31,32,33,34,35,37,38,40,41,42,43],and 0–43% in group 2 [11,12,13,24,44,45 ](table 3). …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Literature Review of Recombinant Tissue Plasminogen Activator Used for Recent-Onset Submacular Hemorrhage Displacement in Age-Related Macular Degeneration

Zeeburg

Meurs

2012

Ophthalmologica

View full text Add to dashboard Cite

show abstract

“…12 The technique has since been evaluated, and favourable results have been reported in several published series. [13][14][15] However, most of these studies were observational, with no control group to compare the anatomic and visual outcomes of AMD patients treated by gas displacement with and without t-PA.…”

Section: Introductionmentioning

confidence: 99%

Effects of intravitreal gas with or without tissue plasminogen activator on submacular haemorrhage in age-related macular degeneration

et al. 2007

Eye

View full text Add to dashboard Cite

Purpose To compare the anatomic and functional outcomes of treating thick submacular haemorrhage with intravitreal gas injection with and without tissue plasminogen activator (t-PA) in patients with age-related macular degeneration. Methods A review of age-related macular degeneration patients with submacular haemorrhage who underwent intravitreal gas injection with and without t-PA at a tertiary referral centre was conducted. Main outcome measures were best and final postoperative visual acuity. Results A total of 53 eyes of 53 patients were included, 28 eyes received intravitreal t-PA and gas injection (t-PA and gas group) and 25 eyes received intravitreal gas injection alone (gas-alone group). Incidence of best visual acuity improvement was significantly higher in the t-PA and gas group than in the gas-alone group (60.7 vs 32.0%; P ¼ 0.037). However, subgroup analysis demonstrated that the difference was significant only in eyes with haemorrhage duration of more than 14 days (46.2 vs 8.3%; P ¼ 0.035). Incidence of final visual acuity improvement was not significantly different between the two groups (42.9 vs 28.0%; P ¼ 0.39). The complications of vitreous haemorrhage and endophthalmitis were similar between the two groups. Multiple logistic regression analysis demonstrated that shorter haemorrhage duration (o14 days) was the main factor predictive of best visual acuity improvement (OR ¼ 9.02, P ¼ 0.015). Whether t-PA was used was of borderline significance (OR ¼ 4.96, P ¼ 0.046). AbstractConclusions Intravitreal t-PA was valuable for submacular haemorrhage only in eyes with relatively old haemorrhage. For eyes with recent onset of haemorrhage, t-PA is suggested only if initial gas injection failed to displace submacular haemorrhage.

show abstract

“…The procedure was performed with topical anesthesia, 25-100 μg tPA in 0.1-0.2 ml injected into the vitreous cavity through the pars plana, followed by a 0.3-to 0.4-ml injection of perfluoropropane (C 3 F 8 ) or sulfur hexafluoride (SF 6 ) gas and 24-hour prone positioning. However, subsequent case series from Germany [26][27][28][29][30], Austria [31], China [32], Thailand [33], and Australia [34] using similar techniques were less impressive, with results ranging from 38 to 64% demonstrating a ≥2 ETDRS line gain. Larger series from Asia also included idiopathic polypoidal choroidal vasculopathy, retinal macroaneurysms, and pathologic myopia, although the outcomes were similar to those reported for AMD patients [35,36].…”

Section: Pneumatic Displacementmentioning

confidence: 91%

Subretinal Hemorrhage

Yiu

Mahmoud²

2014

Developments in Ophthalmology

View full text Add to dashboard Cite

Large submacular hemorrhage (SMH) is a devastating complication of neovascular age-related macular degeneration (AMD) that cannot be effectively managed with anti-vascular endothelial growth factor injections alone. While SMH is not common, AMD patients with existing coagulopathies or taking anticoagulant medications are particularly susceptible. Today, various techniques are available for the management of SMH, including pneumatic displacement with or without intravitreal tissue plasminogen activator (tPA), pars plana vitrectomy with subretinal tPA and gas tamponade, and submacular surgery with vitrectomy and retinotomy for clot extraction. While no consensus exists, the preferred technique is often determined by the extent or duration of the hemorrhage and surgeon preference. This chapter reviews treatment options for managing SMH, as well as the current evidence for supporting their use.

show abstract

Management of submacular hemorrhage by tissue plasminogen activator and SF6 gas injection

Abstract: Toxic and hypoxic damage of foveolar photoreceptors by subretinal hemorrhage can be prevented by early and minimal invasive fibrinolytic therapy. After localization of choroidal neovascularizations, treatment by focal laser coagulation is possible in some cases.

Cited by 15 publications

References 11 publications

Literature Review of Recombinant Tissue Plasminogen Activator Used for Recent-Onset Submacular Hemorrhage Displacement in Age-Related Macular Degeneration

Literature Review of Recombinant Tissue Plasminogen Activator Used for Recent-Onset Submacular Hemorrhage Displacement in Age-Related Macular Degeneration

Effects of intravitreal gas with or without tissue plasminogen activator on submacular haemorrhage in age-related macular degeneration

Subretinal Hemorrhage

Contact Info

Product

Resources

About