Abboud M, Benzerroug M, Milazzo S
Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France.
Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France.
J Fr Ophtalmol. 2017 Feb;40(2):133-137. doi: 10.1016/j.jfo.2016.07.020. Epub 2017 Feb 9.
The occurrence of a subretinal hematoma in age-related macular degeneration (AMD) is a serious complication that can impact the visual prognosis with a poor functional recovery. The management of this complication remains controversial. Several therapeutic methods have been described. We report the results of four patients treated with a protocol combining: vitrectomy, subretinal injection of r-TPA 0.025mg/0.3ml, intravitreal injection of 0.05ml of bevacizumab and retinal tamponade with 20% SF6 gas.
Our series consists of four patients with a submacular hematoma complicating AMD, included in succession between October 2013 and October 2014 and treated with the same treatment protocol and by the same surgeon. All patients underwent surgery within eight days after the onset of the macular hematoma. Patients with a consultation period longer than eight days did not undergo this treatment. Face down postoperative positioning was then carried out for seven days by the patients.
We observed a shift in the macular hematoma in the four patients, which allowed the identification of secondary neovascularization responsible for the bleeding. The visual acuity improved in three patients from hand motion (HM) preoperatively to 2/10 at one month postoperatively. One patient maintained visual acuity 1/20 during the entire follow-up despite almost complete resorption of the subretinal hematoma. These visual acuities were stable at 6 months postoperatively.
Macular subretinal hematoma can cause severe visual loss by several mechanisms. The blood accumulates between the neurosensory retina and the retinal pigment epithelium, which causes a toxic effect on the surrounding tissues, thus resulting in a loss of photoreceptors and cellular destruction in the pigment epithelium and choriocapillaris, evolving into a fibroglial scar.
The therapeutic evaluation of this protocol in our series of four patients gives a favorable result. We observed an improvement in visual acuity in 3/4 of cases. This surgical technique appears to be effective in the treatment of this complication of AMD. However, a study on a larger scale is needed to confirm these results.
年龄相关性黄斑变性（AMD）中发生视网膜下血肿是一种严重并发症，可影响视力预后且功能恢复较差。该并发症的治疗仍存在争议。已有多种治疗方法被描述。我们报告了4例采用以下联合方案治疗的患者的结果：玻璃体切除术、视网膜下注射0.025mg/0.3ml的重组组织型纤溶酶原激活剂（r-TPA）、玻璃体内注射0.05ml贝伐单抗以及用20%的六氟化硫（SF6）气体进行视网膜填塞。
我们的系列研究包括4例患有黄斑下血肿并发AMD的患者，于2013年10月至2014年10月期间相继纳入，并采用相同的治疗方案且由同一位外科医生进行治疗。所有患者在黄斑血肿出现后八天内接受手术。会诊时间超过八天的患者未接受此治疗。术后患者需面部朝下体位保持七天。
我们观察到4例患者黄斑血肿发生移位，这使得能够识别导致出血的继发性新生血管。3例患者的视力从术前的手动视力（HM）提高到术后1个月时的2/10。1例患者尽管视网膜下血肿几乎完全吸收，但在整个随访期间视力维持在1/20。这些视力在术后6个月时保持稳定。
黄斑下视网膜血肿可通过多种机制导致严重视力丧失。血液积聚在神经感觉视网膜和视网膜色素上皮之间，对周围组织产生毒性作用，从而导致光感受器丧失以及色素上皮和脉络膜毛细血管的细胞破坏，进而演变为纤维胶质瘢痕。
在我们这4例患者系列中对该方案的治疗评估取得了良好结果。我们观察到3/4的病例视力有所改善。这种手术技术似乎对治疗AMD的这种并发症有效。然而，需要更大规模的研究来证实这些结果。
