Treatment of hematomas in age related macular degeneration by vitrectomy and subretinal injection of r-tPA: Preliminary results

Boiché, Mathilde; Angioï-Duprez, K.; Conart, Jean‐Baptiste; Berrod, J.–P.

doi:10.1016/j.jfo.2019.07.002

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…Patients were managed surgically after a mean period of 7.1 days, which was in the same range as other similar publications (mean of 6.4 days in Plemel et al [9] and 4.9 days in Treumer et al [4,16]). The percentage of patients on anticoagulants or antiplatelet therapy was also comparable with other studies [4,8]. We found an anatomical success rate (complete displacement of MaH) of 82% (81% in Boiché et al) [8] and visual acuity stabilization or improvement in 84.6% of cases at month 6, which was comparable with other publications [17,18].…”

Section: Discussionsupporting

confidence: 90%

“…The percentage of patients on anticoagulants or antiplatelet therapy was also comparable with other studies [4,8]. We found an anatomical success rate (complete displacement of MaH) of 82% (81% in Boiché et al) [8] and visual acuity stabilization or improvement in 84.6% of cases at month 6, which was comparable with other publications [17,18]. Surgical complications occurred in 7.6% of cases at 1 month (intravitreal hemorrhage (IVH), rhegmatogenous retinal detachment (RRD)); and in 12.3% of cases at 6 months (RRD, recurrence of MaH).…”

Section: Discussionsupporting

confidence: 88%

“…The demographic characteristics of our patients were similar to those reported in other publications using the same surgical techniques [4,8,9]. Our patients had a mean age of 78 years, and we had a slightly higher proportion of females.…”

Section: Discussionsupporting

confidence: 82%

“…The most widely used is complete pars plana vitrectomy (PPV) after induction of posterior vitreous detachment (PVD), subretinal injection of r-tPA, intravitreal filling with gas, and pre and post-operative injections of anti-VEGF agents. According to Boiché et al [8], early surgical management using this technique results in an 81% displacement rate, and visual acuity improvement in 76.9% of treated eyes.…”

Section: Introductionmentioning

confidence: 99%

“…While the risk factors of macular hemorrhage have been repeatedly suggested to include (at least in AMD) systemic hypertension, antiplatelet and anticoagulant intake and possibly the anti-VEGF therapy itself [3], the prognostic factors of visual improvement after surgical therapy have been described only in a few publications [4,8,9]. The role of pro-active regimes in AMD has not been scrutinized in this context.…”

Section: Introductionmentioning

confidence: 99%

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Macular Hemorrhage Due to Age-Related Macular Degeneration or Retinal Arterial Macroaneurysm: Predictive Factors of Surgical Outcome

Pierre

Adam

Chatziralli

et al. 2021

JCM

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Objective: The study aimed to determine the outcomes and prognostic factors of vitrectomy, subretinal injection of tissue-plasminogen activator and gas tamponade in macular hemorrhage (MaH) due to age-related macular degeneration (AMD) or retinal arterial macroaneurysm (RAM). Methods: The study design utilized a multicentric retrospective case series design of consecutive patients undergoing surgery between 2014 and 2019. Results: A total of 65 eyes from 65 patients were included in the study. Surgery was performed after a mean period of 7.1 days. Displacement of MaH was achieved in 82% of the eyes. Mean best-corrected visual acuity (BCVA) improved from 20/500 to 20/125 at month(M)1 and M6 (p < 0.05). At M6, BCVA worsening was associated with an older age at diagnosis (p = 0.0002) and higher subretinal OCT elevation of MaH (p = 0.03). The use of treat and extend (TE) (OR = 16.7, p = 0.001) and small MaH fundus size (OR = 0.64 and 0.74 for horizontal and vertical fundus size, p < 0.05) were predictive of a higher likelihood of obtaining a countable BCVA at M1. Baseline BCVA was predictive of postoperative BCVA (p < 0.05). Retinal detachment and MaH recurrence occurred in 3% and 9.3% of cases at M6. Conclusion: MaH surgery stabilizes or improves BCVA in 85% of cases. Younger age at diagnosis, better baseline BCVA figures, smaller subretinal MaH height and use of TE regime were predictive of the best postoperative outcomes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Macular Hemorrhage Due to Age-Related Macular Degeneration or Retinal Arterial Macroaneurysm: Predictive Factors of Surgical Outcome

Pierre

Adam

Chatziralli

et al. 2021

JCM

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Management of Submacular Hemorrhage

Mohammed

Simon²,

Gorman³

et al. 2022

Curr Surg Rep

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Submacular Hemorrhage during Neovascular Age-Related Macular Degeneration: A Meta-Analysis and Meta-Regression on the Use of tPA and Anti-VEGFs

Veritti,

Sarao,

Martinuzzi

et al. 2024

Ophthalmologica

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Background: Submacular hemorrhage (SMH) associated with neovascular age-related macular degeneration (nAMD) precipitates rapid visual decline and impacts quality of life. Treatments vary, but combined recombinant tissue plasminogen activator (tPA) and anti-vascular endothelial growth factor (anti-VEGF) therapy has gained prominence as a viable treatment option. Objectives: This study aims to evaluate the efficacy of the combination of tPA and anti-VEGF. Methods: We conducted a systematic review meta-analysis following PRISMA guidelines, focusing on studies examining tPA and anti-VEGF therapy in SMH secondary to nAMD. Outcomes measured were change in best-corrected visual acuity (BCVA) and success rate of SMH displacement. Meta-regression assessed the relative efficacy of intravitreal and subretinal delivery. Results: Out of 257 initial reports, 22 studies involving 29 patient populations met inclusion criteria. Our analysis showed significant improvement in BCVA and a high rate of successful SMH displacement with combined tPA and anti-VEGF therapy. No significant differences were found between subretinal and intravitreal tPA administration. Furthermore, when evaluating the effects of subretinal versus intravitreal anti-VEGF administration in patients treated with subretinal tPA, the results indicated similar efficacy. Conclusions: Combined tPA and anti-VEGF therapy is effective in managing SMH in nAMD patients, significantly improving visual acuity and SMH displacement. The location of tPA and anti-VEGF delivery did not significantly impact outcomes.

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Treatment of hematomas in age related macular degeneration by vitrectomy and subretinal injection of r-tPA: Preliminary results

Cited by 6 publications

References 15 publications

Macular Hemorrhage Due to Age-Related Macular Degeneration or Retinal Arterial Macroaneurysm: Predictive Factors of Surgical Outcome

Macular Hemorrhage Due to Age-Related Macular Degeneration or Retinal Arterial Macroaneurysm: Predictive Factors of Surgical Outcome

Management of Submacular Hemorrhage

Submacular Hemorrhage during Neovascular Age-Related Macular Degeneration: A Meta-Analysis and Meta-Regression on the Use of tPA and Anti-VEGFs

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