Department of Ophthalmology, School of Medicine, Nihon University, Kanda, Chiyodaku, Tokyo, Japan.
Department of Ophthalmology, School of Medicine, Nihon University, Kanda, Chiyodaku, Tokyo, Japan.
Ophthalmology. 2016 Jun;123(6):1278-86. doi: 10.1016/j.ophtha.2016.01.035. Epub 2016 Mar 2.
To investigate the efficacy of intravitreal injection of recombinant tissue plasminogen activator (rt-PA), ranibizumab, and gas without vitrectomy for submacular hemorrhage.
Prospective, interventional, consecutive case series.
Twenty consecutive patients (20 eyes) with submacular hemorrhage secondary to exudative age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV).
Ranibizumab, rt-PA (25 μg/0.05 ml), and 100% perfluoropropane (0.3 ml) were injected intravitreally, followed by 2-day prone positioning.
The primary outcome measure was best-corrected visual acuity (BCVA) 6 months after treatment. Secondary outcome measures included central retinal thickness (CRT), central pigment epithelial detachment (PED) thickness, central ellipsoid zone, recurrence rate, and complications.
Underlying disease was exudative AMD in 1 eye and PCV in 19 eyes. Submacular hemorrhage ranged in size from 2 to 31 disc diameters. Complete displacement of submacular hemorrhage was achieved in 17 eyes (85%), and partial displacement was achieved in 3 eyes (15%). Snellen BCVA improved from 20/139 before treatment to 20/65 at 6 months (P = 0.0061). Mean change in Early Treatment Diabetic Retinopathy Study score from baseline was +13 letters (P = 0.0040). Mean CRT decreased from 599 μm before treatment to 208 μm at 6 months (P < 0.0001), and central PED thickness decreased from 188 to 88 μm (P = 0.0140). Three eyes developed vitreous hemorrhage, and 1 eye developed retinal detachment; all were treated surgically, and Snellen BCVA improved at 6 months (P = 0.0012). Recurrence was observed in 10 eyes (50%) within 6 months, but visual acuity was preserved with intravitreal injection of anti-vascular endothelial growth factor (VEGF) pro re nata (PRN). The factors that affect BCVA at 6 months after treatment were pre- and posttreatment central ellipsoid zone (P = 0.0366 and P = 0.0424), pretreatment BCVA (P = 0.0015), and pre- and posttreatment central PED thickness (P = 0.0046, P = 0.0021).
Subretinal hemorrhage treatment by intravitreal injection of rt-PA, ranibizumab, and gas is useful to achieve hemorrhage displacement and lesion improvement. To preserve visual acuity, early detection of posttreatment recurrence and intravitreal anti-VEGF injection PRN are necessary.
研究眼内注射重组组织纤溶酶原激活物（rt-PA）、雷珠单抗和气体而不进行玻璃体切割治疗黄斑下出血的疗效。
前瞻性、干预性、连续病例系列。
20 例连续患者（20 只眼），继发于渗出性年龄相关性黄斑变性（AMD）或息肉样脉络膜血管病变（PCV）的黄斑下出血。
眼内注射雷珠单抗、rt-PA（25 μg/0.05 ml）和 100%全氟丙烷（0.3 ml），然后行 2 天俯卧位。
治疗后 6 个月的最佳矫正视力（BCVA）是主要观察指标。次要观察指标包括中心视网膜厚度（CRT）、中心色素上皮脱离（PED）厚度、中心椭圆体带、复发率和并发症。
1 只眼为渗出性 AMD，19 只眼为 PCV。黄斑下出血大小从 2 到 31 个视盘直径不等。17 只眼（85%）完全移位黄斑下出血，3 只眼（15%）部分移位。治疗前 Snellen BCVA 为 20/139，治疗后 6 个月提高至 20/65（P=0.0061）。从基线到早期治疗糖尿病视网膜病变研究评分的平均变化为+13 个字母（P=0.0040）。治疗前 CRT 平均值为 599 μm，治疗后 6 个月为 208 μm（P＜0.0001），中心 PED 厚度从 188 μm 降低至 88 μm（P=0.0140）。3 只眼发生玻璃体积血，1 只眼发生视网膜脱离；所有患者均接受手术治疗，治疗后 6 个月 Snellen BCVA 提高（P=0.0012）。治疗后 6 个月内 10 只眼（50%）复发，但通过玻璃体腔内注射抗血管内皮生长因子（VEGF）适时治疗保留了视力。治疗后 6 个月时影响 BCVA 的因素为治疗前后的中心椭圆体带（P=0.0366 和 P=0.0424）、治疗前 BCVA（P=0.0015）以及治疗前后的中心 PED 厚度（P=0.0046，P=0.0021）。
眼内注射 rt-PA、雷珠单抗和气体治疗黄斑下出血有助于实现出血移位和病变改善。为了保持视力，有必要早期发现治疗后复发，并适时进行玻璃体腔内抗 VEGF 注射。
