Displacement of Submacular Hemorrhages in Age-Related Macular Degeneration with Subretinal Tissue Plasminogen Activator and Air

作者：Kadonosono Kazuaki^*; Arakawa Akira; Yamane Shin; Inoue Maiko; Yamakawa Tadashi; Uchio Eiichi; Yanagi Yasuo

来源：Ophthalmology, 2015, 122(1): 123-128.

DOI：10.1016/j.ophtha.2014.07.027

Objective: To study the anatomic and visual outcomes of a surgical procedure in which tissue plasminogen activator and air are injected subretinally to displace massive submacular hemorrhages secondary to age-related macular degeneration.
Design: Prospective, consecutive, interventional case series.
Participants: Thirteen consecutive patients (13 eyes) with massive submacular hemorrhages secondary to age-related macular degeneration.
Intervention: The surgical procedure consisted of a 25-gauge vitrectomy and submacular injection of tissue plasminogen activator (25 mu g) and 0.4 ml air with a microneedle having an outer diameter of 50 mu m. The procedure was followed by having the patient remain in the prone position overnight.
Main Outcome Measures: Mean visual acuity change from baseline, mean central lesion thickness change from baseline, fluorescein angiography findings, and surgical complications.
Results: Total subfoveal blood displacement was achieved in all 13 eyes (100%). Central lesion thickness decreased from a mean baseline value of 867 mm to a mean value of 379 mu m at 1 month after surgery. There was visual improvement in 11 eyes, no visual improvement in 1 eye, and poorer vision in 1 eye. The mean change in Early Treatment Diabetic Retinopathy Study letter score from baseline was 19.4 letters at 1 month (P = 0.006) and 23.3 letters at 3 months (P = 0.001). There was intraoperative macular hole formation.
Conclusions: Submacular air injection with a microneedle facilitates displacement of clots dissolved with tissue plasminogen activator with fewcomplications and results in earlier visual improvement.

• 出版日期2015-1