Kishikova Lyudmila, Saad Ahmed Abdelwahab A, Vaideanu-Collins Daniela, Isac Marco, Hamada Dina, El-Haig Wael M
James Cook University Hospital, Middlesbrough, UK.
Zagazig University, Zagazig, Egypt.
Eur J Ophthalmol. 2021 Sep;31(5):2621-2624. doi: 10.1177/1120672120959551. Epub 2020 Sep 29.
To compare the outcome of vitrectomy, subretinal tissue plasminogen activator (TPA), and gas with and without subretinal air versus Intravitreal TPA and gas in the treatment of submacular haemorrhage (SMH) due to Neovascular age related macular degeneration.
We analysed the notes of 29 cases presented with SMH in the period between 01/2016 and 09/2018 at James Cook University Hospital. Presenting visual acuity (BCVA), size and location of SMH, Procedure done, final BCVA at 6 months and any surgical complications were recorded. 11 Cases (Group 1) received intravitreal TPA (50 µg in 0.1 ML), 0.3 ml of pure sulfur hexafluoride (SF6). 18 cases (Group 2) received 23 G Pars Plana vitrectomy, Subretinal TPA injection (25 µg in 0.1 ml), and 20% SF6 gas filling. Group 2 was further divided into 2A (10 patients) who received only subretinal TPA and group 2B (8 patients) who received additional 0.1 ml subretinal air.
The mean BCVA at presentation was 0.0068 in group 1 and 0.0067 in group 2 ( = 0.8734). The mean postoperative BCVA at 6 months was 0.31 in group 1 and 0.58 in group 2 ( = 0.0015). Subgroup analysis of group 2 didn't show statistically significant difference in outcome when adding subretinal air to the vitrectomy procedure ( = 0.7009).
Vitrectomy, gas and subretinal TPA has more successful displacement rate and better visual outcome than Intravitreal TPA & Gas alone in treating SMH involving the fovea in age-related macular degeneration. Additional subretinal air doesn't seem to improve the outcome in cases having vitrectomy.
比较玻璃体切除术、视网膜下组织型纤溶酶原激活剂（TPA）联合气体填充（有无视网膜下空气）与玻璃体内注射TPA联合气体填充治疗新生血管性年龄相关性黄斑变性所致黄斑下出血（SMH）的效果。
我们分析了2016年1月至2018年9月期间在詹姆斯库克大学医院就诊的29例SMH患者的病历。记录患者的初始视力（最佳矫正视力，BCVA）、SMH的大小和位置、所进行的手术、6个月时的最终BCVA以及任何手术并发症。11例患者（第1组）接受玻璃体内注射TPA（50μg溶于0.1ml），0.3ml纯六氟化硫（SF6）。18例患者（第2组）接受23G经平坦部玻璃体切除术、视网膜下TPA注射（25μg溶于0.1ml）以及20% SF6气体填充。第2组进一步分为2A组（10例患者），仅接受视网膜下TPA治疗；2B组（8例患者），除视网膜下TPA外，还接受额外的0.1ml视网膜下空气。
第1组初始时的平均BCVA为0.0068，第2组为0.0067（P = 0.8734）。第1组6个月时的平均术后BCVA为0.31，第2组为0.58（P = 0.0015）。第2组的亚组分析显示，在玻璃体切除术中添加视网膜下空气，结果无统计学显著差异（P = 0.7009）。
在治疗年龄相关性黄斑变性累及黄斑中心凹的SMH时，玻璃体切除术、气体填充联合视网膜下TPA比单纯玻璃体内注射TPA联合气体填充具有更高的成功复位率和更好的视力预后。在接受玻璃体切除术的病例中，额外的视网膜下空气似乎并未改善预后。
