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INTRAVITREAL TISSUE PLASMINOGEN ACTIVATOR, PERFLUOROPROPANE (C3F8), AND RANIBIZUMAB OR PHOTODYNAMIC THERAPY FOR SUBMACULAR HEMORRHAGE SECONDARY TO WET AGE-RELATED MACULAR DEGENERATION.
MedLine Citation:
PMID:  23400079     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE:: To report a combined intravitreal treatment for submacular hemorrhage. METHODS:: This retrospective, noncomparative, interventional case series included 7 patients with neovascular age-related macular degeneration and 2 with idiopathic polypoidal choroidal vasculopathy, presenting with fovea-involving submacular hemorrhage ≥ 4 disk areas in size, of <10 days of duration. All patients received a single 0.05-mL intravitreal injection of 50 μg alteplase, 0.3 mL of 100% C3F8, and facedown positioning for 1 week. Patients with newly diagnosed age-related macular degeneration received 3 consecutive monthly intravitreal injections of 0.5 mg ranibizumab, followed by monthly retreatment as needed. Those with idiopathic polypoidal choroidal vasculopathy were treated with photodynamic therapy. RESULTS:: Mean (±SD) logarithm of the minimum angle of resolution visual acuity improved from 0.75 ± 0.35 at presentation to 0.35 ± 0.30 at a mean final follow-up of 15.1 months (P = 0.0078). Median Snellen acuity improved from 20/200 to 20/32. Visual acuity was stable in one case and improved in eight. The average size of submacular hemorrhage was 6.8 disk areas at presentation, reducing to 2.6 within 1 month (P = 0.0039). Subfoveal hemorrhage was displaced in all cases within 9 weeks. The mean pretreatment central retinal thickness of 669 μm reduced to 528 μm (P = 0.0039). One case developed transiently elevated intraocular pressure. Two developed breakthrough vitreous hemorrhage. No adverse events were attributed to tissue plasminogen activator. CONCLUSION:: Tissue plasminogen activator and C3F8, combined with intravitreal ranibizumab or photodynamic therapy, may result in anatomical clearance of submacular hemorrhage and improved visual acuity, in a condition with an otherwise poor visual prognosis.
Authors:
Evangelia Papavasileiou; David H W Steel; Efstathios Liazos; Dominic McHugh; Timothy L Jackson
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-7
Journal Detail:
Title:  Retina (Philadelphia, Pa.)     Volume:  -     ISSN:  1539-2864     ISO Abbreviation:  Retina (Philadelphia, Pa.)     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309919     Medline TA:  Retina     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Ophthalmology, King's College Hospital, London, United Kingdom †Sunderland Eye Infirmary, Sunderland, United Kingdom ‡School of Medicine, King's College London, London, United Kingdom.
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