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Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration


Sacu, S; Stifter, E; Vécsei-Marlovits, P V; Michels, S; Schütze, C; Prünte, C; Schmidt-Erfurth, U (2009). Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration. Eye, 23(6):1404-1410.

Abstract

Background: To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy.
Methods: This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed.
Results: Mean baseline VA was 0.15plusminus0.2 and 0.25plusminus0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1plusminus0.14; P=0.003), and a stabilization in group B (mean difference: +0.008plusminus0.2; P=0.94). CRT decreased significantly by 70 mum in group A (P=0.001) and by 84 mum in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm2 and 19.1 mm2 at baseline and 0.0 mm2 and 2.0 mm2 at month 4, respectively. The anti-VEGF treatmentrate was 1.6 in group A and 3.0 in group B.
Conclusion: In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.

Background: To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy.
Methods: This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed.
Results: Mean baseline VA was 0.15plusminus0.2 and 0.25plusminus0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1plusminus0.14; P=0.003), and a stabilization in group B (mean difference: +0.008plusminus0.2; P=0.94). CRT decreased significantly by 70 mum in group A (P=0.001) and by 84 mum in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm2 and 19.1 mm2 at baseline and 0.0 mm2 and 2.0 mm2 at month 4, respectively. The anti-VEGF treatmentrate was 1.6 in group A and 3.0 in group B.
Conclusion: In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Ophthalmology Clinic
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:subfoveal haemorrhage, recombinant tissue plasminogen activator, gas, avastin, lucentis
Language:English
Date:June 2009
Deposited On:07 Nov 2008 12:50
Last Modified:05 Apr 2016 12:32
Publisher:Nature Publishing Group
ISSN:0950-222X
Publisher DOI:10.1038/eye.2008.267
Official URL:http://www.nature.com/eye/journal/vaop/ncurrent/pdf/eye2008267a.pdf
PubMed ID:18756282
Permanent URL: http://doi.org/10.5167/uzh-5073

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