Effects of intravitreal gas with or without tissue plasminogen activator on submacular haemorrhage in age-related macular degeneration

Abstract

To compare the anatomic and functional outcomes of treating thick submacular haemorrhage with intravitreal gas injection with and without tissue plasminogen activator (t-PA) in patients with age-related macular degeneration. A review of age-related macular degeneration patients with submacular haemorrhage who underwent intravitreal gas injection with and without t-PA at a tertiary referral centre was conducted. Main outcome measures were best and final postoperative visual acuity. A total of 53 eyes of 53 patients were included, 28 eyes received intravitreal t-PA and gas injection (t-PA and gas group) and 25 eyes received intravitreal gas injection alone (gas-alone group). Incidence of best visual acuity improvement was significantly higher in the t-PA and gas group than in the gas-alone group (60.7 vs 32.0%; P=0.037). However, subgroup analysis demonstrated that the difference was significant only in eyes with haemorrhage duration of more than 14 days (46.2 vs 8.3%; P=0.035). Incidence of final visual acuity improvement was not significantly different between the two groups (42.9 vs 28.0%; P=0.39). The complications of vitreous haemorrhage and endophthalmitis were similar between the two groups. Multiple logistic regression analysis demonstrated that shorter haemorrhage duration (<14 days) was the main factor predictive of best visual acuity improvement (OR=9.02, P=0.015). Whether t-PA was used was of borderline significance (OR=4.96, P=0.046). Intravitreal t-PA was valuable for submacular haemorrhage only in eyes with relatively old haemorrhage. For eyes with recent onset of emorrhage, t-PA is suggested only if initial gas injection failed to displace submacular haemorrhage.