Hemorrhage In Age-related Macular Degeneration Research Articles

Predictive factors for Submacular Hemorrhage in Age-related Macular Degeneration: A Retrospective Study.

Little is known about the major risk factors for submacular hemorrhage (SMH). This study aimed to evaluate the factors associated with SMH in patients with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) receiving three consecutive loading doses of intravitreal aflibercept or ranibizumab injections. This retrospective cross-sectional study included 48 patients diagnosed with wAMD and PCV who completed three loading doses under a treat-and-extend regimen. Patients were divided into the SMH group (n=24) and the non-SMH group (age- and sex-matched without SMH). Intravitreal injections, agents, and optical coherence tomography (OCT) features were compared. In the SMH group, SMH occurred approximately 3.29 years after post-nAMD diagnosis. The non-SMH group received more intravitreal injections of aflibercept and brolucizumab during the follow-up period after the initial loading phase. The SMH group exhibited a higher prevalence of serous/hemorrhagic pigment epithelial detachments (PEDs) at the last visit before SMH occurrence compared to the non-SMH group. Patients with a PED increase in the past two visits showed a higher tendency in the SMH group. No other OCT features significantly correlated with SMH development. The presence of serous/hemorrhagic PEDs may indicate a higher risk of SMH, and eyes with these features should be closely monitored to prevent sudden and devastating visual loss caused by SMH.

Принципы терапии субретинальных кровоизлияний

Purpose. To study approaches to the treatment of submacular hemorrhage in age-related macular degeneration based on the literature data. Material and methods. The search for publications on the treatment of submacular hemorrhage (SMH) was carried out in the PubMed, SCOPUS, Umedp databases, as well as manually in journals and publications of conference materials until January 2021. Results and discussion. SMH treatment is represented by a variety of methods, from minimally invasive methods, such as intravitreal injection of drugs, gas tamponade and their combinations, to complex surgical approaches with pigment epithelium transplantation. Conclusions. The successful treatment of massive SMH is possible with minimally invasive methods. However, with significant prominating SMH, vitreoretinal surgical interventions are more appropriate. It is advisable to treat SMH as soon as possible from the moment of hemorrhage. Key words: submacular hemorrhage, age-related macular degeneration, pneumodislocation, vitrectomy, anti-VEGF inhibitors, tissue plasminogen activator.

Combined Administration of Preoperative Intravitreal and Intraoperative Subretinal Recombinant Tissue Plasminogen Activator in Acute Hemorrhagic Age-related Macular Degeneration.

PurposeTo evaluate the efficacy of combining pre-operative intravitreal administration of recombinant tissue plasminogen activator (rTPA) followed by 23G pars plana vitrectomy with the subretinal administration of rTPA in the management of acute submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (AMD).MethodsThis is a single-center case series report that included 14 patients with SMH secondary to neovascular AMD. All of them received preoperative intravitreal injection of 0.05 ml (50 µg) rTPA, followed on the next day by 23G pars plana vitrectomy with subretinal 0.1 ml (10 µg) rTPA administration and air tamponade.ResultsThere was a significant (p=0.01) overall improvement in the visual acuity post-treatment (from 1.4±0.5 log MAR to 0.9±0.4). The mean overall change in the visual acuity post-treatment was 0.5±0.3 log MAR (mean % change=31.7±15.1). There was a significant (p=0.03) overall reduction in the central macular thickness post-treatment (896±608.1 µm to 497.2±196.0 µm). The mean overall change in the central macular thickness post-treatment was 398.8±458.1 µm (mean % change=38.1±18.1).ConclusionCombined treatment of 24 hours of preoperative administration of intravitreal rTPA followed the next day by vitrectomy and the administration of subretinal rTPA with air tamponade appeared to be effective as a prompt intervention in managing acute SMH secondary to neovascular AMD. However, similar studies with larger sample size and a control comparative group are warranted to further confirm these findings.

LONG-TERM RESULTS OF AUTOLOGOUS RETINAL PIGMENT EPITHELIUM AND CHOROID TRANSPLANTATION FOR THE TREATMENT OF EXUDATIVE AND ATROPHIC MACULOPATHIES.

To evaluate the long-term results of autologous retinal pigment epithelium (RPE) and choroid transplantation (RPE-choroid patch) for exudative and atrophic maculopathies. Consecutive chart review of 120 eyes, which underwent RPE-choroid patch, from 2007 to 2017 for RPE atrophy or choroidal neovascular membrane secondary to exudative and hemorrhagic age-related macular degeneration, myopia, angioid streaks, and laser. Eyes were tested with best-corrected visual acuity (BCVA), reading ability, optical coherence tomography, fluorescein angiography and indocyanine green angiography, autofluorescence, and microperimetry. Eighty-eight eyes of 84 patients had complete data, with 2- to 10-year follow-up. Mean age was 71.9 ± 9.06 years. Mean preoperative and postoperative BCVA was 20/320 (1.2 ± 0.2 logMAR) and 20/200 (0.94 ± 0.36 logMAR), respectively (P = 0.009). Reading ability recovered in 43% of cases. Microperimetry showed central fixation. A gain of at least 15 letters was obtained in 40% of eyes. Integrity (P = 0.009) of external limiting membrane and higher preoperative BCVA (P = 0.001) predicted better final BCVA. Complications were retinal detachment (11.4%), macular atrophy (7%), subretinal hemorrhage (4.5%), epiretinal membrane (4.5%), recurrent choroidal neovascular membrane (4.5%), macular hole (3.4%), and cystoid edema (3%). Autologous RPE-choroid patch achieved long-lasting BCVA improvement and central fixation, in eyes with choroidal neovascular membrane and intact external limiting membrane. Atrophic maculopathies only obtained temporary visual benefit.

Subretinal Tenecteplase Injection for Submacular Hemorrhage in Age-related Macular Degeneration

Subretinal Tenecteplase Injection for Submacular Hemorrhage in Age-related Macular Degeneration

Histopathology observation of hemorrhagic age-related macular degeneration

Ovjective To observe the surgically excised specimens from eyes with hemorrhagic agerelated macular degeneration (AMD).Methods Thirty-six surgically excised specimens were captured from 36 patients with hemorrhagic AMD,26 specimens were diagnosed as occult choroidal neovascular membrane (CNVM),10 specimens were diagnosed as polypoidal choroidal vasculopathy (PCV).All specimens were routinely processed by hematoxylin and eosin,periodic acid-Schiff's stain and Masson stainings.At the maximum horizontal and vertical slice of the specimens,the category and amount of the cells in the specimen were recorded,as well as the relationship between the specimens and the surrounding tissue.Results The 36 specimens are categorized as neovascular membrane dominant (19/36),collagen fiber dominant (6/36),blood clot dominant (8/36) and degenerated thickened Bruch's membrane dominant (3/36).Eighteen occult CNVM specimens and 1 PCV specimen are categorized as neovascular membrane dominant; all 6 collagen fiber dominant specimens are occult CNVM; 1 occult CNVM and 7 PCV specimens are categorized as blood clot dominant; and 1 occult CNVM and 2 PCV specimens are categorized as degenerated thickened Bruch's membrane dominant.The occult CNVM categorized as neovascular membrane dominant present as small blood vessel with single endothelium cell attached; the PCV specimen categorized as neovascular dominant presents as big blood vessel with thick vessel wall under the Bruch's membrane,retinal pigment epithelium and choroidal melanocyte are both observed in the PCV specimens.Conclusion The components of the specimens captured from eyes with hemorrhagic AMD are diversified. Key words: Macular degeneration/pathology; Choroid diseases/pathology; Retinal neovascularization/pathology

Morphologic Features and Viability Analysis of Human Detached Retinal Pigment Epithelium in Age-Related Macular Degeneration

To evaluate the morphologic features and viability of human retinal pigment epithelium (RPE) cells captured from the pigment epithelium detachment (PED) region outside the choroidal neovascular membrane lesion in eyes with hemorrhagic age-related macular degeneration. Prospective, observational case series. Five specimens of the RPE sheet were obtained from the PED region after choroidal neovascular membrane excision in 5 eyes of 5 patients during RPE transplantation for hemorrhagic age-related macular degeneration. The specimens were stained with hematoxylin and eosin and with periodic acid-Schiff. Immunohistochemistry analysis for RPE-65 and zonula occludens-1 also was performed. RPE cells from the PED region were cultured and passaged 5 times. Scanning and transmission electron microscopy were performed to analyze the specimens. The RPE cells of the specimens contained brownish pigment and were autofluorescent in vitro. Periodic acid-Schiff staining revealed that the Bruch membrane below the RPE monolayer was not intact. The specimens demonstrated positive results for both zonula occludens-1 and RPE-65 staining. The RPE basement membrane in the specimen was observed by both scanning and transmission electron microscopy. Intercellular tight junctions among RPE cells of the specimen also were observed. RPE cells captured from the PED region were cultured successfully and were passaged 5 times. The RPE sheet developed from the PED region outside the choroidal neovascular membrane lesion had tight intercellular junctions, a simple RPE basement membrane, and active cellular viability. This monolayer RPE sheet may be considered as a substitution for subfoveal RPE loss in eyes with hemorrhagic age-related macular degeneration.

A pedicled autologous choroid RPE patch: a technique to preserve perfusion.

The aim of the study is to report a technique of a pedicled autologous choroid retinal pigment epithelium (RPE) patch that aims to preserve perfusion of the transplanted tissue. A case report of a patient with sudden vision deterioration due to submacular hemorrhage in age-related macular degeneration. The surgery involved a 180-degree peripheral retinectomy and the creation of a pedicled graft instead of an isolated one. Outcome measures included preoperative and postoperative visual acuity and optical coherence tomography scans at 1, 3, 6, 12 months and patch vascularization on postoperative indocyanine green angiography. Postoperatively the patch was positioned under the fovea with an intact pedicle. Indocyanine green angiography showed perfusion through the pedicle and patch vasculature on the third postoperative day. Best corrected visual acuity improved from 0.5/50 to 5/50 at 1 month and remained stable over 1 year follow-up. No choroidal neovascularization recurrence was observed. This case report demonstrates the feasibility of a pedicled RPE-choroid graft that is an alternative to a free isolated graft. Our modification of patch surgery, by demonstrating early perfusion, offers an advantage, similar to macular translocation, when photoreceptors are embedded in RPE and choroid with blood circulation immediately after the surgery.

Tissue plasminogen activator (tPA) in the management of predominantly hemorrhagic age-related macular degeneration, milligram/milliliter or microgram/milliliter?

Recently our hospital pharmacy, which serves an academic hospital with an internationally well-known department of ophthalmology, received a request for the aseptic preparation of an alteplase syringe solution for subretinal administration. Looking for dose rationale, our ophthalmology doctor came up with a concentration based on an article published by Arias and colleagues in Clinical Ophthalmology in 2010.1 This article is on subretinal alteplase administration for hemorrhagic age-related macular degeneration. In the methods section, a concentration of 125 mg/mL alteplase was declared, which we found peculiar. This concentration cannot be acquired with the commercially available preparation (which has a maximum concentration of 2 mg/mL), and could lead to undesirable side effects. In the literature, it is stated that an alteplase dose should be in the range of 200 μg/mL.2 Did the authors mean 125 μg/mL?

Minocycline Attenuates Photoreceptor Degeneration in a Mouse Model of Subretinal Hemorrhage: Microglial Inhibition as a Potential Therapeutic Strategy

Minocycline Attenuates Photoreceptor Degeneration in a Mouse Model of Subretinal Hemorrhage: Microglial Inhibition as a Potential Therapeutic Strategy

Intravitreal Ranibizumab in the Treatment of Predominantly Hemorrhagic Lesions in Exudative Age-Related Macular Degeneration

Submacular hemorrhage is a manifestation of neovascular age-related macular degeneration (AMD) that has a very poor natural history leading to severe visual loss. We have evaluated the safety and efficacy of intravitreal ranibizumab in the treatment of predominantly hemorrhagic AMD. A retrospective study of patients with predominantly hemorrhagic AMD treated with intravitreal ranibizumab at the Jules Gonin Eye Hospital between December 2006 and December 2008 was undertaken. Baseline and monthly follow-up exams included visual acuity (VA), fundus exam and optical coherence tomography (OCT) while fluorescein and indocyanine green angiography were performed at least every three months. The study included 8 eyes. The mean follow-up was 13 months (SD: 6.3). The mean number of intravitreal injections administered for each patient was 6.4 (SD: 2). 50 % of the patients demonstrated stable or improved VA. The size of hemorrhage at baseline was inversely correlated to the final VA (two-tailed p value = 0.038) and positively correlated to the final central macular thickness (two-tailed p value = 0.021). Anticoagulation treatment was inversely correlated to the time of hemorrhage resolution (two-tailed p value = 0.039). Intravitreal ranibizumab may be an effective treatment for predominantly hemorrhagic lesions due to neovascular AMD.

Anticoagulation and intraocular haemorrhage in age‐related macular degeneration: a probable link?

Medical Journal of AustraliaVolume 192, Issue 4 p. 228-229 Lessons from practice Anticoagulation and intraocular haemorrhage in age-related macular degeneration: a probable link? Rajeev Chalasani MB BS, Corresponding Author Rajeev Chalasani MB BS Ophthalmology Registrar rajeev.chalasani@eyeandear.org.au Royal Victorian Eye and Ear Hospital, Melbourne, VIC.Correspondence: rajeev.chalasani@eyeandear.org.auSearch for more papers by this authorSalmaan Qureshi FRANZCO, Salmaan Qureshi FRANZCO Retinal Specialist Royal Victorian Eye and Ear Hospital, Melbourne, VIC.Search for more papers by this author Rajeev Chalasani MB BS, Corresponding Author Rajeev Chalasani MB BS Ophthalmology Registrar rajeev.chalasani@eyeandear.org.au Royal Victorian Eye and Ear Hospital, Melbourne, VIC.Correspondence: rajeev.chalasani@eyeandear.org.auSearch for more papers by this authorSalmaan Qureshi FRANZCO, Salmaan Qureshi FRANZCO Retinal Specialist Royal Victorian Eye and Ear Hospital, Melbourne, VIC.Search for more papers by this author First published: 15 February 2010 https://doi.org/10.5694/j.1326-5377.2010.tb03485.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume192, Issue4February 2010Pages 228-229 RelatedInformation

Transconjunctival sutureless vitrectomy with tissue plasminogen activator, gas and intravitreal bevacizumab in the management of predominantly hemorrhagic age-related macular degeneration

To determine the efficacy and safety of treating predominantly hemorrhagic age-related macular degeneration (AMD) with transconjunctival sutureless vitrectomy (TSV), tissue plasminogen activator (tPA), sulphur hexafluoride (SF6), and intravitreal bevacizumab. Retrospective study, consecutive case series. Patients with acute hemorrhagic AMD treated with 25- or 23-gauge TSV, subretinal or intravitreal tPA, fluid-air-SF6 exchange and intravitreal injection of bevacizumab. All operations were performed within the first 5 days after the start of symptoms, which consisted of visual acuity (VA) loss and central scotoma. Fifteen eyes from 15 patients were included. The patients' mean age was 79.6 years, and the mean follow-up was 11.8 months. Five patients (33%) were receiving oral anticoagulant treatment. At baseline, the mean VA (logMAR values) was 1.5 (20/640 Snellen equivalent). At the last follow-up visit, the mean VA was 1.1 (20/250) (P < 0.0001; paired t-test). The submacular hemorrhage was successfully displaced in all the cases. Complications consisted of three cases of vitreous hemorrhage and a tear or the retinal pigment epithelium. Twelve cases (80%) did not require further treatment during the follow-up period. A surgical approach with 25- or 23-gauge TSV, tPA, SF6 and intravitreal bevacizumab is an efficacious and safe procedure in patients with hemorrhagic AMD. Early treatment is advisable for obtaining the optimal outcome.

Submacular Combination Treatment for Management of Acute, Massive Submacular Hemorrhage in Age-Related Macular Degeneration

A surgical technique is described combining submacular anti-vascular endothelial growth factor (anti-VEGF) and recombinant tissue plasminogen activator (r-TPA) with pneumatic displacement of massive submacular hemorrhage in age-related macular degeneration. An 84-year-old man with a large, acute submacular hemorrhage secondary to age-related macular degeneration underwent combination vitrectomy, submacular anti-VEGF and r-TPA injection with pneumatic displacement of the hemorrhage. At the last follow-up visit, 7 months after surgery, visual acuity was 20/80 with a small fibrovascular pigment epithelial detachment and atrophic retinal pigment epithelial changes. A 77-year-old woman with known age-related macular degeneration underwent a similar surgical procedure for a similar acute, large submacular hemorrhage related to age-related macular degeneration. Nine months after surgery, the visual acuity was 20/70(-1). Combination submacular anti-VEGF therapy delivered at the time of pars plana vitrectomy and submacular tissue plasminogen activator assisted hemorrhage displacement may be a viable treatment strategy for the management massive submacular hemorrhage.

Autologous Transplantation of Retinal Pigment Epithelium–Bruch’s Membrane Complex for Hemorrhagic Age-Related Macular Degeneration

To evaluate a surgical procedure for patients with hemorrhagic age-related macular degeneration (AMD). This procedure consisted of excision of the choroidal neovascular membrane and transplantation of autologous retinal pigment epithelium (RPE)-Bruch's membrane complex. The RPE-Bruch's membrane complex for transplantation was surgically developed by dissecting Bruch's membrane with the choriocapillaris from the medium size choroidal vessel layer at the midperipheral region of the choroid. Twenty-one eyes of 21 patients had this surgical procedure. Visual function tests included best corrected visual acuity (BCVA), multifocal (mf)ERG, and microperimetry. Optical coherence tomography (OCT), fluorescein angiography, and autofluorescence examinations were performed to study the status of the transplanted graft. Among the 21 eyes, 17 with complete clinical data and qualified follow-up durations, which were 20.35 +/- 10.31 months on average, were analyzed in this series. On the last follow-up visit, the mean for the ETDRS scores increased from 28.65 +/- 23.99 before surgery to 47.76 +/- 17.22 after surgery. Microperimetry showed that after surgery, seven eyes gained central fixation at the 12-month follow-up examination. However, two eyes lost their central fixation on the last follow-up visit. Fourteen (82.35%) of the transplanted patches preserved normal color without depigmentation. Among the 21 eyes, proliferative vitreoretinopathy (PVR) occurred in 3 (14.29%), and a recurrent neovascular membrane was observed in one eye (4.76%). The transplantation of the autologous RPE-Bruch's membrane complex can increase the visual acuity of patients with hemorrhagic AMD. The surviving transplanted graft with functional overlying retina was observed after surgery.

Intravitreal Injection of tPA and Gas for Submacular Hemorrhage Associated with Age-related Macular Degeneration

Purpose: To study the results of intravitreal tissue plasminogen activator (tPA) and expansile gas injection for the treatment of submacular hemorrhage in age-related macular degeneration (AMD). Methods: Eleven consecutive patients (11 eyes) with submacular hemorrhage in AMD were included in this study. All patients were treated with intravitreal injections of tPA and C3F8 gas. Postoperatively, patients' follow-up period were at least 3 months. Outcome measures included early and final visual acuity, age, disc areas of hemorrhage, duration of symptoms, displacement of blood from the fovea, and final macular status. Results: The maximum diameter of the hematoma ranged from 2 to 10 disc diameters. The mean duration of submacular hemorrhage was 7.5 days. Submacular blood was completely displaced in 7 patients (64%) and partially in four (36%). Best postoperative visual acuity improved in 7 eyes; in 6 eyes (55%), the improvement was two or more lines. Final visual acuity improved in 7 eyes (64%), remained stable in 2 eyes (18%), and worsened in 2 eyes (18%). Choroidal neovascularization positioned at subfovea in 7 eyes (64%) and juxtafovea in 4 eyes (36%). No significant difference was found between postoperative visual recovery and these factors. Conclusions: Our findings suggest that intravitreal tPA and expansile gas injection are safe and of useful for displacing hemorrhages secondary to age-related macular degeneration. Final visual acuity was limited by the underlying choroidal neovascularization of AMD.

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

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.

Triamcinolone and PDT to Treat Exudative Age-Related Macular Degeneration and Submacular Hemorrhage

To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin and intravitreal injection of triamcinolone to treat choroidal neovascularization (CNV) with flat sub-macular hemorrhage in age-related macular degeneration (ARMD). A prospective, consecutive, noncomparative, interventional case series study was performed at the Instituto Oftalmologico de Alicante, Spain. Ten consecutive eyes from 10 patients with flat submacular hemorrhage secondary to ARMD were treated by PDT followed by intravitreal injection of 19.4+/-2.1 mg/0.1 mL triamcinolone 5 days later. PDT was repeated if leakage from the CNV appeared on fluorescein angiography (FA) at 3 months follow-up intervals. Main outcome measures were best-corrected visual acuity (BCVA) before and after treatment, post-treatment FA, results, and complications. Stable or improved BCVA was achieved in seven eyes at 6 months follow-up. Complete absence of leakage in FA was observed in five and in eight eyes at 3 and 6 months follow-up, respectively. Intraocular pressure rose in seven eyes. PDT followed by intravitreal triamcinolone seems useful to treat CNV with flat submacular hemorrhage in ARMD. However, further studies with longer follow-up and randomized controlled trials are necessary to assess its efficacy in the management of this difficult clinical problem.

Photodynamic Therapy for Choroidal Neovascularization Associated With Submacular Hemorrhage in Age-Related Macular Degeneration

To describe visual acuity results after photodynamic therapy (PDT) with verteporfin for choroidal neovascularization in age-related macular degeneration (AMD) associated with large submacular hemorrhage (SMH). Eyes that had AMD, at least 12 months' follow-up, and SMH of at least 2.5 mm2, and had received no other treatment modality in conjunction with PDT, were divided into two groups: eyes with spontaneous SMH that was treated with PDT and eyes with SMH that occurred following PDT treatment. The presence of SMH did not preclude the patients from undergoing further PDT. Mean acuity of the spontaneous SMH group was 20/294 initially and 20/252 after 12 months. Mean acuity of the post-PDT SMH group was 20/336 initially and 20/406 after 12 months. Initial and 12-month acuities in both groups were not statistically different. Mean size of the hemorrhage was 11.5 mm2 in the spontaneous SMH group and 17.8 mm2 in the post-PDT SMH group. Subgroup analysis showed no statistically significant difference between initial and final visual acuities, regardless of the presence of blood under the fovea. Analysis by size of the SMH showed only the spontaneous SMH group with hemorrhages over 10 mm2 to have a statistically significant difference in visual acuity at 12 months (P= .0001; initial acuity, 20/230; 12-month acuity, 20/456). Eyes treated with PDT for choroidal neovascularization associated with submacular hemorrhage and AMD maintained stable vision over 12 months.

Long-term results after surgical extraction of subfoveal choroidal neovascular membranes with and without haemorrhage in age-related macular degeneration.

Surgical extraction has been suggested as a treatment of choroidal neovascular membranes. We demonstrate the long-term results of our patients regarding complications, risk of recurrence and development of visual acuity. We have retrospectively evaluated the charts and re-examined the patients who underwent surgical extraction of choroidal neovascular membranes (CNV) because of age-related macular degeneration (AMD) between March 1994 and December 2000 in the Department of Ophthalmology of the Benjamin Franklin Clinic, Berlin. Fifty-two eyes of 49 patients with a minimum follow-up of 12 months after pars plana vitrectomy with CNV extraction and SF6-endotamponade were included. Initially, in 15% of all eyes the lesions were obscured by intravitreal haemorrhage. All visible lesions were located subfoveally. In 40% of all eyes the lesion was predominantly classic; 21% of the lesions were predominantly occult and 23% of the lesions were comprised of more than 50% haemorrhage. The maximum follow-up was 80 months, the mean 46 months. The median initial visual acuity was 0.08 (range: hand movements to 0.4) and the median final visual acuity was not significantly different at 0.067 (range: non lux to 0.4). A loss of less than three lines of visual acuity occurred in 65.4% of our patients. During follow-up, 25% of eyes developed a rhegmatogenous retinal detachment and 19.2% of all eyes suffered from recurrence of CNV. At the end of the follow-up, three eyes (5.8%) suffered from non-treated retinal detachment and three eyes (5.8%) had recurrent CNV lesions. All eyes showed a retinal pigment epithelium defect at the site of former CNV. A stabilisation of visual acuity in individual patients with CNV because of AMD can be achieved by surgical extraction, yet the defect of the RPE and the risk of complications limit the benefit. We consider the surgical extraction of CNV from AMD in patients with low initial visual acuity who are not amenable to PDT.