TY - JOUR
T1 - 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
AU - Liu, Enchun M.
AU - Rajagopal, Rithwick
AU - Smith, Bradley T.
AU - Grand, M. Gilbert
N1 - Publisher Copyright:
© The Author(s) 2017.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - anti-VEGF agents
KW - choroidal neovascularization
KW - dry AMD (nonneovascular)
KW - fovea
KW - macula
KW - retina
KW - retinal pigment epithelium
KW - small-gauge vitrectomy
KW - submacular hemorrhage
KW - wet AMD (neovascular)
UR - http://www.scopus.com/inward/record.url?scp=85058018279&partnerID=8YFLogxK
U2 - 10.1177/2474126416680670
DO - 10.1177/2474126416680670
M3 - Article
AN - SCOPUS:85058018279
SN - 2474-1264
VL - 1
SP - 34
EP - 40
JO - Journal of VitreoRetinal Diseases
JF - Journal of VitreoRetinal Diseases
IS - 1
ER -