Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Str. 3, Haus 25, 24105 Kiel, Germany.
Graefes Arch Clin Exp Ophthalmol. 2010 Jan;248(1):5-11. doi: 10.1007/s00417-009-1158-7. Epub 2009 Aug 11.
To compare the efficacy of pars plana vitrectomy (ppV) with intravitreal injection of recombinant tissue plasminogen activator (rtPA) and gas versus ppV with subretinal injection of rtPA and intravitreal injection of gas.
Nonrandomized, retrospective, interventional, comparative consecutive series including 47 patients with submacular hemorrhage. Eighteen patients were treated with ppV, intravitreal injection of rtPA and 20% SF6 gas [group A: mean age 78 years, mean duration of symptoms 6.6 days, 15 age-related macular degeneration (AMD), three retinal arterial macroaneurysm (RAMA)]. Twenty-nine patients were treated with ppV, subretinal injection of rtPA and intravitreal injection of SF6 gas (group B: mean age 75 years, mean duration of symptoms 5.9 days, 26 AMD, two RAMA, one blunt ocular trauma). The main outcome measure was complete displacement of submacular hemorrhage from the fovea.
Complete displacement of submacular hemorrhage was achieved in less patients in group A (22%) than in group B (55%) (p = 0.025). In group A, mean best-corrected visual acuity (BCVA) change was logMAR -0.14, standard deviation (SD) = 0.64, and in group B logMAR -0.32, SD = 0.68 without statistically significant difference between the two groups (p = 0.2, Mann-Whitney test). Complications (retinal detachment, vitreous hemorrhage, and recurrence of submacular hemorrhage) were more frequent in group B than in group A.
ppV with subretinal injection of rtPA and intravitreal injection of gas was more effective than ppV with intravitreal injection of rtPA and gas in terms of complete displacement of submacular hemorrhage; however, it may be associated with a higher rate of postoperative complications. Functional improvement in the majority of patients suggests the absence of direct retinal toxicity of subretinally applied rtPA.
比较经睫状体平坦部玻璃体切除术（ppV）联合玻璃体内注射重组组织型纤溶酶原激活剂（rtPA）与气体填充，与 ppV 联合视网膜下注射 rtPA 与玻璃体内注射气体填充的疗效。
本研究为非随机、回顾性、干预性、连续对照系列研究，共纳入 47 例黄斑下出血患者。18 例患者接受 ppV、玻璃体内注射 rtPA 与 20%六氟化硫（SF6）气体治疗（A 组：平均年龄 78 岁，平均症状持续时间 6.6 天，15 例年龄相关性黄斑变性（AMD），3 例视网膜动脉大动脉瘤（RAMA））。29 例患者接受 ppV、视网膜下注射 rtPA 与玻璃体内注射 SF6 气体治疗（B 组：平均年龄 75 岁，平均症状持续时间 5.9 天，26 例 AMD，2 例 RAMA，1 例钝挫伤）。主要观察指标为黄斑下出血是否完全从黄斑区移位。
A 组完全移位的患者（22%）少于 B 组（55%）（p = 0.025）。A 组患者最佳矫正视力（BCVA）的平均变化为 logMAR-0.14，标准差（SD）=0.64，B 组为 logMAR-0.32，SD=0.68，两组间无统计学差异（p = 0.2，Mann-Whitney 检验）。B 组并发症（视网膜脱离、玻璃体积血和黄斑下出血复发）的发生率高于 A 组。
与 ppV 联合玻璃体内注射 rtPA 与气体填充相比，ppV 联合视网膜下注射 rtPA 与玻璃体内注射气体填充更有利于黄斑下出血的完全移位，但可能与术后并发症发生率较高相关。大多数患者的功能改善提示视网膜下应用 rtPA 不存在直接的视网膜毒性。
