scholarly journals Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage

2007 ◽  
Vol 91 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Y Oshima ◽  
M Ohji ◽  
Y Tano
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Pars Plana Vitrectomy ◽  
Subretinal Haemorrhage ◽  
Tissue Plasminogen ◽  
Pars Plana

scholarly journals Outcomes of pars plana vitrectomy with subretinal tissue plasminogen activator injection and pneumatic displacement of fovea-involving submacular haemorrhage

2020 ◽  
Vol 5 (1) ◽  
pp. e000394 ◽  
Author(s):  
Carl S Wilkins ◽  
Neesurg Mehta ◽  
Chris Y Wu ◽  
Alexander Barash ◽  
Avnish A Deobhakta ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Pars Plana Vitrectomy ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Case Series ◽  
Subretinal Haemorrhage ◽  
Tissue Plasminogen ◽  
Pneumatic Displacement ◽  
Pars Plana

ObjectiveFovea-involving subretinal haemorrhage is challenging to manage with uncertain visual outcomes. We reviewed outcomes of patients with fovea-involving macular haemorrhage treated with pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) with pneumatic displacement.Methods and AnalysisThis is a retrospective interventional case series. All patients with submacular haemorrhage who underwent PPV with subretinal tPA injection were included. Reasons for exclusion encompassed patients who underwent intravitreal tPA injection in the office without surgery, insufficient follow-up or documentation. Primary outcomes of interest were postoperative visual acuity (VA) at month 1 and 3. Secondary outcomes were median VA at month 3 by location of haemorrhage and underlying diagnosis.ResultsThirty-seven total patients were included. The mean age was 68.2 years, with 54.1% (20/37) females. The most common aetiology was exudative macular degeneration (43.2%), followed by undifferentiated choroidal neovascularisation (CNV) (18.9%), polypoidal choroidal vasculopathy (18.9%), traumatic CNV (10.8%), macroaneurysm (5.4%) and proliferative diabetic retinopathy (2.7%). Median preoperative VA was 20/2000, postoperative month 1 was 20/347 (p<0.01), improving to 20/152 (p<0.01) at month 3. Proportion of patients gaining vision 3+ lines in vision was 15/36 (42%). Mean preoperative central subfield thickness on optical coherence tomography was 512.2 µm for sub-retinal pigment epithelium haemorrhage and 648.2 µm for subretinal haemorrhage (p=0.48). Difference in VA by diagnosis was not significant (p=0.60).ConclusionsPPV with subretinal tPA injection and pneumatic displacement of submacular haemorrhage offers modest visual recovery for a diverse group of patients. Location of haemorrhage or specific diagnosis may not predict outcome.

Management of Large Submacular Hemorrhages Due to Exudative AMD Utilizing Pars Plana Vitrectomy, Subretinal Tissue Plasminogen Activator, and Gas Insertion Compared With Antivascular Endothelial Growth Factor Alone

2017 ◽  
Vol 1 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Enchun M. Liu ◽  
Rithwick Rajagopal ◽  
Bradley T. Smith ◽  
M. Gilbert Grand
Keyword(s):  
Growth Factor ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Pars Plana Vitrectomy ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Tissue Plasminogen ◽  
Pars Plana ◽  
Endothelial Growth Factor ◽  
Surgical Group

Purpose: To assess the outcomes of patients with large submacular hemorrhage (SMH) due to age-related macular degeneration in this era of anti-vascular endothelial growth factor (VEGF). Methods: Retrospective analysis of 149 eyes of 149 patients receiving pars plana vitrectomy, subretinal tissue plasminogen activator, and gas injection (“surgical group”; n = 80) or anti-VEGF alone (“anti-VEGF group”; n = 69). Changes in visual acuity (VA), number of anti-VEGF injections, and percentage of patients with ≥3 line VA gains are compared between groups. Results: Patients in the surgical group had larger SMH than those in the anti-VEGF group, 30.35 versus 14.57 mm2 ( P < .0001). Both groups experienced similar visual gains (−0.35 logarithm of the minimal angle of resolution [logMAR] vs −0.23 in logMAR, surgical vs anti-VEGF group; P = .36). The percentage of patients gaining ≥3 lines of VA was 55% in the surgical group and 54% in the anti-VEGF group. The surgical group achieved best-recorded VA sooner (3.7 compared to 4.6 months; P = .04) and required fewer injections (3.4 injections vs 4.7 in the anti-VEGF group; P = .001). Conclusion: Surgical intervention was favored for larger hemorrhages of shorter duration. Despite extensive hemorrhage and poor baseline VA, both groups showed similar rate of significant VA improvement.

Treatment of submacular hemorrhage with tissue plasminogen activator and pneumatic displacement in age-related macular degeneration

2019 ◽  
pp. 112067211989162
Author(s):  
Jan Janusz Sniatecki ◽  
Gregory Ho-Yen ◽  
Benjamin Clarke ◽  
Ramez Barbara ◽  
Stephen Lash ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Pars Plana Vitrectomy ◽  
Age Related Macular Degeneration ◽  
Control Group ◽  
Submacular Hemorrhage ◽  
Age Related ◽  
Tissue Plasminogen ◽  
Pars Plana

Purpose: To evaluate visual and anatomic outcomes following pars plana vitrectomy and intravitreal or subretinal tissue plasminogen activator for submacular hemorrhage in patients with age-related macular degeneration. Methods: This was a retrospective study on patients with a minimum follow-up of 12 months undertaken at a tertiary referral center. Data collected include demographic details, visual and optical coherence tomography changes, surgical details, and complications. Surgical results were compared with patients who were age and lesion size matched and treated with anti-vascular endothelial growth factor injections alone. Results: There were 36 patients in surgical and 18 patients in control group. Patients in surgical arm had pars plana vitrectomy, intravitreal tissue plasminogen activator with air 24 (67%), 6 (16%) with C3F8 gas, 1 (3%) with SF6 gas, 4 (11%) subretinal tissue plasminogen activator with air, and 1 (3%) with C2F6 as post-operative tamponade. Mean LogMAR in tissue plasminogen activator group at baseline was 1.56, and it was improved at all time points 1.06 at 1 month (p < 0.05), 0.91 at 6 months (p < 0.05), and 1.07 at 1 year (p < 0.05). Mean best corrected visual acuity in control group at baseline was 1.22LogMAR with no significant improvement at any time points: 1 month (1.27), 6 months (1.35), and 12 months (1.36). Complications included retinal detachment 5%, vitreous hemorrhage 7.5%, and cataract 19%. Conclusion: Pars plana vitrectomy with intravitreal (or subretinal) tissue plasminogen activator and pneumatic displacement can offer better outcome in comparison to anti-vascular endothelial growth factor alone in patients with submacular hemorrhage secondary to age-related macular degeneration.

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