Vitrectomy with subretinal tissue plasminogen activator and ranibizumab for submacular haemorrhages secondary to age-related macular degeneration: retrospective case series of 45 consecutive cases

González-López, Julio J.; McGowan, Gerard; Chapman, E; Yorston, David

doi:10.1038/eye.2016.65

Cited by 33 publications

(27 citation statements)

References 27 publications

(27 reference statements)

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“…Visual outcomes in our patients are like those previously reported in several exudative AMD studies,7 8 11 and had greater improvement than in others 9 10. One study by Gonzalez-Lopez et al reported slightly better outcomes with intervention earlier than 8 days, worse outcomes by area of haemorrhage and a similar overall final BCVA to this cohort at roughly 12-month follow-up 12. More than half of our patients gained vision, with 41.7% of patients gaining significant vision of 3 or more lines at 3 months (figure 1A,B).…”

Section: Discussionsupporting

confidence: 87%

Outcomes of pars plana vitrectomy with subretinal tissue plasminogen activator injection and pneumatic displacement of fovea-involving submacular haemorrhage

Wilkins

Mehta

et al. 2020

BMJ Open Ophth

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ObjectiveFovea-involving subretinal haemorrhage is challenging to manage with uncertain visual outcomes. We reviewed outcomes of patients with fovea-involving macular haemorrhage treated with pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) with pneumatic displacement.Methods and AnalysisThis is a retrospective interventional case series. All patients with submacular haemorrhage who underwent PPV with subretinal tPA injection were included. Reasons for exclusion encompassed patients who underwent intravitreal tPA injection in the office without surgery, insufficient follow-up or documentation. Primary outcomes of interest were postoperative visual acuity (VA) at month 1 and 3. Secondary outcomes were median VA at month 3 by location of haemorrhage and underlying diagnosis.ResultsThirty-seven total patients were included. The mean age was 68.2 years, with 54.1% (20/37) females. The most common aetiology was exudative macular degeneration (43.2%), followed by undifferentiated choroidal neovascularisation (CNV) (18.9%), polypoidal choroidal vasculopathy (18.9%), traumatic CNV (10.8%), macroaneurysm (5.4%) and proliferative diabetic retinopathy (2.7%). Median preoperative VA was 20/2000, postoperative month 1 was 20/347 (p<0.01), improving to 20/152 (p<0.01) at month 3. Proportion of patients gaining vision 3+ lines in vision was 15/36 (42%). Mean preoperative central subfield thickness on optical coherence tomography was 512.2 µm for sub-retinal pigment epithelium haemorrhage and 648.2 µm for subretinal haemorrhage (p=0.48). Difference in VA by diagnosis was not significant (p=0.60).ConclusionsPPV with subretinal tPA injection and pneumatic displacement of submacular haemorrhage offers modest visual recovery for a diverse group of patients. Location of haemorrhage or specific diagnosis may not predict outcome.

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Section: Discussionsupporting

confidence: 87%

Outcomes of pars plana vitrectomy with subretinal tissue plasminogen activator injection and pneumatic displacement of fovea-involving submacular haemorrhage

Wilkins

Mehta

et al. 2020

BMJ Open Ophth

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“…Another study used subretinal ranibizumab [27]. e mixture consisted of 0.5-0.7 ml of rtPA 125 μg/ml and 0.06 ml of ranibizumab 10 mg/ml for submacular haemorrhages secondary to neovascular age-related macular degeneration [27].…”

Section: Discussionmentioning

confidence: 99%

“…Subretinal injection of anti-VEGFs was reported in several studies for the treatment of submacular haemorrhage due to exudative age-related macular degeneration [26,27]. e subretinal space, by definition, is the space between RPE cells and photoreceptors [28].…”

Section: Introductionmentioning

confidence: 99%

Sub-macular Injection of Ranibizumab as a New Surgical Treatment for Refractory Diabetic Macular Edema

2019

CMR

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In this study, we describe a new surgical technique for the treatment of refractory DME. e technique consists of vitrectomy with ILM peeling with a subretinal injection of ranibizumab. Methods. is is a prospective interventional noncomparative study including patients with refractory DME. Included patients were subjected to the new surgical technique of pars plana vitrectomy with subretinal injection of ranibizumab. Results. e study included 19 eyes with refractory macular edema, in which this novel technique was attempted. ere were 10 males and 9 females. e age of the patients ranged from 17 to 67 years with a mean of 55.58 ± 13.242 years. e duration of diabetes before enrollment in the study ranged from 7 to 25 years with a mean of 16.3 years. Preoperatively, the mean CMT of the eyes ranged from 352 to 883 microns with mean ± SD of 498.58 ± 152.16 microns. Postoperatively, this improved significantly to 373.5 ± 100.3, 355.9 ± 89.8, and 365.74 ± 120.12 microns at 1, 3, and 6 months, respectively (p ≤ 0.001 for all). Conclusion. is novel surgical procedure of vitrectomy with ILM peeling with a subretinal injection of ranibizumab is effective in cases of refractory DME. e study has been registered in Contact ClinicalTrials.gov PRS Identifier: NCT03975088.

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“…Subretinal injection of anti-VEGFs was reported in several studies for the treatment of submacular haemorrhage due to exudative age-related macular degeneration [26, 27].…”

Section: Introductionmentioning

confidence: 99%

Submacular Injection of Ranibizumab as a New Surgical Treatment for Refractory Diabetic Macular Edema

Elbaha

Hadi

Abouhussein

2019

Journal of Ophthalmology

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Purpose In this study, we describe a new surgical technique for the treatment of refractory DME. The technique consists of vitrectomy with ILM peeling with a subretinal injection of ranibizumab. Methods This is a prospective interventional noncomparative study including patients with refractory DME. Included patients were subjected to the new surgical technique of pars plana vitrectomy with subretinal injection of ranibizumab. Results The study included 19 eyes with refractory macular edema, in which this novel technique was attempted. There were 10 males and 9 females. The age of the patients ranged from 17 to 67 years with a mean of 55.58 ± 13.242 years. The duration of diabetes before enrollment in the study ranged from 7 to 25 years with a mean of 16.3 years. Preoperatively, the mean CMT of the eyes ranged from 352 to 883 microns with mean ± SD of 498.58 ± 152.16 microns. Postoperatively, this improved significantly to 373.5 ± 100.3, 355.9 ± 89.8, and 365.74 ± 120.12 microns at 1, 3, and 6 months, respectively (p ≤ 0.001 for all). Conclusion This novel surgical procedure of vitrectomy with ILM peeling with a subretinal injection of ranibizumab is effective in cases of refractory DME. The study has been registered in Contact ClinicalTrials.gov PRS Identifier: NCT03975088.

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Vitrectomy with subretinal tissue plasminogen activator and ranibizumab for submacular haemorrhages secondary to age-related macular degeneration: retrospective case series of 45 consecutive cases

Cited by 33 publications

References 27 publications

Outcomes of pars plana vitrectomy with subretinal tissue plasminogen activator injection and pneumatic displacement of fovea-involving submacular haemorrhage

Outcomes of pars plana vitrectomy with subretinal tissue plasminogen activator injection and pneumatic displacement of fovea-involving submacular haemorrhage

Sub-macular Injection of Ranibizumab as a New Surgical Treatment for Refractory Diabetic Macular Edema

Submacular Injection of Ranibizumab as a New Surgical Treatment for Refractory Diabetic Macular Edema

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