Lewis H
Division of Ophthalmology, Cleveland Clinic Foundation, Ohio 44195.
Am J Ophthalmol. 1994 Nov 15;118(5):559-68. doi: 10.1016/s0002-9394(14)76571-7.
This pilot study determined the safety and efficacy of intraoperative pharmacologic lysis of recent submacular hemorrhage with tissue plasminogen activator followed by surgical drainage of the unclotted blood in patients with age-related macular degeneration.
In a prospective study, 24 consecutive eyes with recent (< 14 days old) submacular hemorrhage secondary to age-related macular degeneration and good visual acuity before development of submacular hemorrhage were treated with vitrectomy, subretinal injection of tissue plasminogen activator, and removal of the liquefied blood. Patients were followed up for at least six months (mean, 14 months).
Twenty eyes (83%) had improved visual acuity after surgery, and eight eyes (33%) attained visual acuity of 20/200 or better. In a subset of 16 eyes with submacular hemorrhage of seven days duration or less, eight (50%) attained visual acuity of 20/200 or better. Factors associated with poor visual outcome included submacular hemorrhage with duration greater than seven days (P < .001), the presence of hemorrhagic pigment epithelial detachment (P = .04), and massive subretinal hemorrhage (P = .04).
Tissue plasminogen activator thrombolysis may be a valuable adjunct to the surgical treatment of select patients with submacular hemorrhages secondary to age-related macular degeneration.
本初步研究确定了组织型纤溶酶原激活剂术中对近期黄斑下出血进行药物溶解，随后对年龄相关性黄斑变性患者未凝固血液进行手术引流的安全性和有效性。
在一项前瞻性研究中，对24只连续的眼睛进行治疗，这些眼睛患有年龄相关性黄斑变性继发的近期（<14天）黄斑下出血，且在黄斑下出血发生前视力良好，治疗方法包括玻璃体切除术、视网膜下注射组织型纤溶酶原激活剂以及清除液化血液。对患者进行了至少六个月（平均14个月）的随访。
20只眼睛（83%）术后视力提高，8只眼睛（33%）达到20/200或更好的视力。在黄斑下出血持续时间为七天或更短的16只眼睛亚组中，8只（50%）达到20/200或更好的视力。与视力不良结果相关的因素包括持续时间大于七天的黄斑下出血（P <.001）、出血性色素上皮脱离的存在（P =.04）和大量视网膜下出血（P =.04）。
组织型纤溶酶原激活剂溶栓可能是对年龄相关性黄斑变性继发黄斑下出血的特定患者进行手术治疗的有价值辅助手段。
