Gok Mustafa, Karabaş V Levent, Aslan Mehmet S, Kara Özgür, Karaman Süleyman, Yenihayat Fatih
Department of Ophthalmology, Ministry of Health, Ordu University Research and Training Hospital, Ordu, Turkey.
Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli, Turkey.
Indian J Ophthalmol. 2017 Jun;65(6):482-487. doi: 10.4103/ijo.IJO_129_16.
The purpose of this study was to evaluate the treatment efficacy of vitrectomy combined with subretinal recombinant tissue plasminogen activator (r-tPA) and factors affecting visual improvement in patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (nAMD).
Medical records of 17 consecutive patients diagnosed with SMH secondary to nAMD were retrospectively reviewed. The initial surgical procedure involved a 23-gauge transconjunctival vitrectomy, subretinal r-tPA application through a self-sealing inferior retinotomy, and sulfur hexafluoride gas for tamponade in all patients. The duration, size, and thickness of the hemorrhage and the pre- and post-operative visual acuity (VA) using a Snellen chart were recorded. VA was converted to logMAR for statistical analysis.
The average duration and size of the SMH were 12.8 ± 18.2 days and 8.6 ± 5.3 disc areas, respectively. The mean follow-up time was 16.9 ± 4.7 months. A statistically significant visual improvement was found when comparing initial VA with postoperative best-corrected VA (BCVA) and final BCVA (Wilcoxon rank test, P ≤ 0.01). There was no significant correlation between the size of the hemorrhage and postoperative BCVA and final BCVA (Spearman's rho test). There was no statistically significant correlation between the initial VA and postoperative BCVA and final BCVA (Spearman's rho test). There was no significant correlation between the duration of hemorrhage and postoperative BCVA and final BCVA (Spearman's rho test). The preoperative thickness of hemorrhage (747.5 ± 30 μm) was not correlated with postoperative BCVA or final BCVA (Pearson's test).
Vitrectomy combined with subretinal r-tPA injection and gas tamponade is an effective surgical intervention to preserve VA in selected patients with apparent SMH.
本研究旨在评估玻璃体切除术联合视网膜下重组组织型纤溶酶原激活剂（r - tPA）治疗新生血管性年龄相关性黄斑变性（nAMD）所致黄斑下出血（SMH）患者的疗效以及影响视力改善的因素。
回顾性分析17例连续诊断为nAMD继发SMH患者的病历。初始手术步骤包括23G经结膜玻璃体切除术、通过自闭性视网膜下切口应用视网膜下r - tPA以及所有患者均使用六氟化硫气体进行填塞。记录出血的持续时间、大小和厚度，以及使用斯内伦视力表测量的术前和术后视力（VA）。将VA转换为logMAR进行统计分析。
SMH的平均持续时间和大小分别为12.8±18.2天和8.6±5.3视盘面积。平均随访时间为16.9±4.7个月。将初始视力与术后最佳矫正视力（BCVA）和最终BCVA进行比较时，发现视力有统计学意义的改善（Wilcoxon秩和检验，P≤0.01）。出血大小与术后BCVA和最终BCVA之间无显著相关性（Spearman等级相关检验）。初始视力与术后BCVA和最终BCVA之间无统计学显著相关性（Spearman等级相关检验）。出血持续时间与术后BCVA和最终BCVA之间无显著相关性（Spearman等级相关检验）。术前出血厚度（747.5±30μm）与术后BCVA或最终BCVA无关（Pearson检验）。
玻璃体切除术联合视网膜下r - tPA注射及气体填塞是一种有效的手术干预措施，可在部分明显SMH患者中保留视力。
