Abstract

P 197

Combined intravitreous use of recombinant Tissue-Plasminogen activator and bevacizumab in subretinal hemorrhages with choroidal neovascularizations

Michael R. R. Böhm, Holger Busse, Constantin E. Uhlig
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Münster, Münster

Objective
Four patients suffering from monolateral retinal hemorrhages due to choroidal neovascularizations had been intravitreally treated with off-label therapy: Medical treatment had been started with combined intravitreal injection of bevazicumab (25 - 50 µg) and rT-PA (25 - 50 µg), followed by two intravitreal injections of bevazicumab (50 µg) in monthly intervals.
Methods
Retrospective analysis. Pre- and postoperative examination included best-corrected visual acuity (BCVA) with Snellen letters (5 m distance), slit-lamp examination, funduscopy, optical coherence tomography (OCT), fluorescein-angiography. Postoperative investigation also included electroretinographic measurements (ERG). Follow up was 30 - 72 months.
Results
BCVA increased in one and decreased in three patients (mean -1,25 lines). In all patients, pigment alterations were observed in the central retina and in one case, the whole posterior pole was affected. Bilateral electroretinographic comparison revealed decreased amplitudes of the affected eyes (mean decrease: 157,88 µV in scotopic and 92,04 µV in photopic conditions). In one case electroretinographic amplitudes were completely deleted.
Conclusions
Treatment of subretinal hemorrhages with intravitreal r-TPA combined with bevacizumab resulted in all four cases in irreversible morphological and electrophysiological alterations and in three cases in decreased visual acuity. It actually remains unclear whether these changes are related to inherent biochemical effects of the hemorrhages, to the intravitreally applicated r-TPA or to its combination with bevacizumab.

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