Shah Sumit P, Hubschman Jean Pierre, Gonzales Christine R, Schwartz Steven D
Jules Stein Eye Institute, Department of Ophthalmology University of California, David Geffen School of Medicine, Los Angeles, California 90095, USA.
Ophthalmic Surg Lasers Imaging. 2009 May-Jun;40(3):308-15. doi: 10.3928/15428877-20090430-16.
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.
本文描述了一种手术技术，即在年龄相关性黄斑变性患者中，将黄斑下抗血管内皮生长因子（anti-VEGF）和重组组织型纤溶酶原激活剂（r-TPA）与黄斑下大量出血的气体置换相结合。一名84岁男性因年龄相关性黄斑变性继发大量急性黄斑下出血，接受了玻璃体切除术、黄斑下抗-VEGF和r-TPA注射以及出血的气体置换联合治疗。在术后7个月的最后一次随访中，视力为20/80，伴有小的纤维血管性色素上皮脱离和萎缩性视网膜色素上皮改变。一名77岁已知患有年龄相关性黄斑变性的女性，因类似的与年龄相关性黄斑变性相关的急性、大量黄斑下出血接受了类似的手术。术后9个月，视力为20/70（-1）。在玻璃体切除术时进行联合黄斑下抗-VEGF治疗以及黄斑下组织型纤溶酶原激活剂辅助的出血置换，可能是治疗黄斑下大量出血的一种可行治疗策略。
