Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Eye (Lond). 2009 Jun;23(6):1404-10. doi: 10.1038/eye.2008.267. Epub 2008 Aug 29.
To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy.
This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed.
Mean baseline VA was 0.15+/-0.2 and 0.25+/-0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1+/-0.14; P=0.003), and a stabilization in group B (mean difference: +0.008+/-0.2; P=0.94). CRT decreased significantly by 70 microm in group A (P=0.001) and by 84 microm in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm(2) and 19.1 mm(2) at baseline and 0.0 mm(2) and 2.0 mm(2) at month 4, respectively. The anti-VEGF treatment rate was 1.6 in group A and 3.0 in group B.
In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.
评估新生血管性年龄相关性黄斑变性（AMD）继发的黄斑下出血的临床结果，这些患者接受了玻璃体内重组组织纤溶酶原激活剂（rTPA）/气体和抗血管内皮生长因子（anti-VEGF）药物治疗，或接受了玻璃体内抗 VEGF 单药治疗。
这是一项回顾性试点研究。接受玻璃体内 rTPA/气体和抗 VEGF 注射（贝伐单抗或雷珠单抗）的患者被纳入 A 组。接受 rTPA/气体注射后拒绝俯卧位且仅接受抗 VEGF 单药（贝伐单抗）治疗的患者被纳入 B 组（n=10）。分析了基线视力（VA，Snellen）、中心视网膜厚度（CRT）和出血大小的变化。
A 组和 B 组的平均基线 VA 分别为 0.15+/-0.2 和 0.25+/-0.17。在第 4 个月，A 组的平均 VA 显著改善（平均差异：+0.1+/-0.14；P=0.003），B 组稳定（平均差异：+0.008+/-0.2；P=0.94）。A 组 CRT 显著降低了 70μm（P=0.001），B 组降低了 84μm（P=0.03）。A 组和 B 组黄斑下出血的平均大小分别为 20.2mm2 和 19.1mm2，在第 4 个月分别为 0.0mm2 和 2.0mm2。A 组的抗 VEGF 治疗率为 1.6，B 组为 3.0。
对于新生血管性 AMD 继发的广泛黄斑下出血患者，rTPA/气动移位联合抗 VEGF 治疗可导致 VA 平均改善和形态学参数稳定。如果 rTPA 和气动移位联合治疗是禁忌的，可进行抗 VEGF 单药治疗以防止视力进一步下降。
