Abstract

SA.16.09

Subretinal co-application of recombinant tissue plasminogen activator and bevacizumab for neovascular age-related macular degeneration with submacular hemorrhage

Jost Hillenkamp, Felix Treumer, Carsten Klatt, Johann Roider
Klinik für Ophthalmologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

Objective
To evaluate efficacy and safety of pars plana vitrectomy (ppV) with subretinal co-application of recombinant tissue plasminogen activator (rtPA) and bevacizumab followed by a gas tamponade for neovascular age-related macular degeneration (AMD) with acute submacular hemorrhage (SMH).
Methods
Consecutive interventional case series of 12 patients with neovascular AMD with SMH with a maximum history of 14 days. All patients underwent ppV with subretinal co-application of rtPA and bevacizumab followed by a gas tamponade. Phakic patients underwent concomitant cataract surgery. Additional injections of bevacizumab were applied intravitreally 4 and 8 weeks postop.
Results
Complete displacement of SMH from the fovea was achieved in 10 of 12 patients. Mean preop best-corrected visual acuity (BCVA) was logMAR 1.9 (range 3.0-0.7), Mean BCVA 4 weeks postop was logMAR 1.2 (range 3.0-0.3), and mean BCVA 12 weeks postop was logMAR 0.9 (range 1.6-0.3). Mean improvement of BCVA at 12 weeks postop as compared to preop was logMAR 0.96 (range 2.8 to -0.3). Overall, BCVA improved in 10 patients, remained unchanged in one patient , and worsened in one patient.
Conclusions
PpV with subretinal co-application of rtPA and bevacizumab followed by an intravitreal gas tamponade effectively displaces submacular hemorrhage in most patients. Functional improvement in most patients suggests the absence of retinal or retinal pigment epithelium toxicity.

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