Depatment of Ophthalmology, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.
Department of Ophthalmology, University of Basel, Basel, Switzerland.
PLoS One. 2021 Apr 30;16(4):e0250587. doi: 10.1371/journal.pone.0250587. eCollection 2021.
To analyze the functional and anatomical outcome after vitrectomy with subretinal rtPA (recombinant tissue plasminogen activator) combined with or without an intravitreal Bevacizumab injection.
Retrospective, consecutive case series of 31 pseudophakic patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (AMD) treated with vitrectomy, subretinal rtPA and pneumatic air displacement with or without an additional intravitreal Bevacizumab injection. The primary endpoints were best-corrected visual acuity (BCVA), and central macular thickness (CMT) measured by SD‑OCT. The secondary endpoint was a displacement of hemorrhage from the subretinal space three months after surgery.
31 eyes of 31 patients were treated with vitrectomy and subretinal rtPA. 17/31 were treated simultaneously with an intravitreal Bevacizumab injection (group +B) and 14/31 without (group -B). The mean visual acuity improved significantly in both groups (from 1.37±0.39 to 1.03±0.57 logMAR in +B and from 1.48±0.48 to 1.01±0.38 logMAR in group -B, p<0.05). The mean CMT decreased in group +B from 607±179 μm to 424±205 μm (p = 0.2) and in group -B from 722±216 μm to 460±202 μm (p<0.05). A central displacement of the hemorrhage could be achieved in 47% in group +B, whereas in group -B displacement could be achieved in 50% (p = 0.44).
Vitrectomy with subretinal rtPA injection and air tamponade with or without simultaneous intravitreal Bevacizumab injection displaces SMH and improves BCVA effectively. In comparison, the postoperative outcome is comparable regardless of whether or not intravitreal bevacizumab is applied simultaneously.
分析玻璃体切除术后视网膜下 rtPA（重组组织纤溶酶原激活物）联合或不联合玻璃体内贝伐单抗注射的功能和解剖结果。
回顾性连续病例系列研究，31 例因新生血管性年龄相关性黄斑变性（AMD）导致黄斑下出血（SMH）的白内障术后患者接受玻璃体切除、视网膜下 rtPA 和气动空气置换联合或不联合玻璃体内贝伐单抗注射治疗。主要终点是最佳矫正视力（BCVA）和 SD-OCT 测量的中心黄斑厚度（CMT）。次要终点是术后 3 个月时从视网膜下空间移位出血。
31 例 31 眼接受玻璃体切除和视网膜下 rtPA 治疗。17/31 例同时接受玻璃体内贝伐单抗注射（+B 组）治疗，14/31 例未接受（-B 组）。两组视力均明显提高（+B 组从 1.37±0.39 提高至 1.03±0.57 logMAR，-B 组从 1.48±0.48 提高至 1.01±0.38 logMAR，p<0.05）。+B 组 CMT 从 607±179μm 降至 424±205μm（p=0.2），-B 组从 722±216μm 降至 460±202μm（p<0.05）。+B 组 47%的患者可实现出血的中心移位，而-B 组可实现 50%的患者（p=0.44）。
玻璃体切除联合视网膜下 rtPA 注射和空气填充联合或不联合玻璃体内贝伐单抗注射可有效移位 SMH 并提高 BCVA。相比之下，无论是否同时应用玻璃体内贝伐单抗，术后结果均相似。
