Visual Outcome after Vitrectomy with Subretinal tPA Injection to Treat Submacular Hemorrhage Secondary to Age-Related Macular Degeneration or Macroaneurysm.

Yasmin Ali Said,Peter Stalmans,Evelien Dewilde,Akio Oishi

doi:10.1155/2021/3160963

Yasmin Ali Said, Peter Stalmans + Show 2 more

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https://doi.org/10.1155/2021/3160963

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Abstract

Purpose To determine the efficacy and safety of 23G transconjunctival sutureless vitrectomy, subretinal injection of tissue plasminogen activator using the EVA Surgical System, and pneumatic displacement with air to treat submacular hemorrhages. Methods Retrospective analysis of 93 eyes surgically treated for submacular hemorrhage caused by neovascular AMD or retinal macroaneurysms. Main Outcome Measures. Postoperative visual acuity and surgical complications. Results After surgery, visual acuity improved after 6 weeks but decreased again at the final postoperative visit at 8 months due to progression of the underlying disease. Complications consisted of 2 cases of retinal pigment epithelial tear, 7 vitreous hemorrhages, 4 hyphema, 6 cases of retinal detachment, and 2 subchoroidal hemorrhages during the follow-up period. Conclusions This study suggests that a surgical approach with 23G vitrectomy, subretinal tPA injection, and pneumatic displacement using air may be an effective procedure for submacular hemorrhage displacement in patients with AMD and retinal macroaneurysms. However, visual outcome is limited by the underlying macular pathology. Larger multicenter randomized controlled studies are warranted to determine the therapeutic effect of this surgical approach.

Highlights

Subretinal hemorrhage is a serious complication of agerelated macular degeneration (AMD) and retinal macroaneurysms which prohibits continued treatment with anti-Vascular Endothelial Growth Factor (VEGF) injections and leads to irreversible retinal damage
We reviewed records of patients, admitted at the University Hospitals Leuven between 2012 and April 2021, treated with 23G transconjunctival sutureless vitrectomy with subretinal tissue Plasmin Activator (tPA) injection using the DORC EVA Surgical System (Zuidland, the Netherlands) and intravitreal air injection to displace the hemorrhage away from the fovea
A 10 ml syringe was filled with this solution and mounted to the viscous fluid injection (VFI) kit (DORC, the Netherlands). e VFI syringed was mounted to an extendible 41gauge polyimide beveled tip microcannula (DORC, the Netherlands). e viscous fluid injection system was connected to and controlled via the EVA Surgical System using variable levels of system-controlled pneumatic pressure. e tip of the injection needle was introduced transretinally into the subretinal space in the lower part of the blood clot, i.e., close to the inferior vascular arcade. e injected volume of tPA was between 0.5 and 1 ml and induced a local bullous retinal detachment over the macular area extending inferiorly since the needle was introduced into the lower area of the blood clot

Summary

Introduction

Subretinal hemorrhage is a serious complication of agerelated macular degeneration (AMD) and retinal macroaneurysms which prohibits continued treatment with anti-Vascular Endothelial Growth Factor (VEGF) injections and leads to irreversible retinal damage. Without treatment, these patients generally have a poor visual prognosis [1,2,3,4]. Displacement of the subretinal blood can be attempted by injecting a gas bubble with or without tissue Plasmin Activator (tPA) in the vitreous cavity and face-down positioning of the patient [1]. The subretinal penetration of tPA is limited, and the positioning of elderly patients is difficult [2]. There are few data on the effect of subretinal injection of tPA combined with air fill of the vitreous cavity

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