Abstract：
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 μg) and 0.4 ml air with a microneedle having an outer diameter of 50 μm. 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 μm to a mean value of 379 μm 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 few complications and results in earlier visual improvement.
journal_name
Ophthalmologyjournal_title
Ophthalmologyauthors
Kadonosono K,Arakawa A,Yamane S,Inoue M,Yamakawa T,Uchio E,Yanagi Ydoi
10.1016/j.ophtha.2014.07.027subject
Has Abstractpub_date
2015-01-01 00:00:00pages
123-8issue
1eissn
0161-6420issn
1549-4713pii
S0161-6420(14)00631-9journal_volume
122pub_type
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