Abstract

AIM: To evaluate efficacy and safety of pars plana vitrectomy (ppV) with subretinal co-application of recombinant tissue plasminogen activator (rtPA) and bevacizumab, and fluid-gas exchange for neovascular age-related macular degeneration (AMD) with submacular hemorrhage (SMH).

METHODS: Consecutive interventional case series of 12 patients with neovascular AMD with SMH with a maximum history of 14 days. All patients underwent ppV with subretinal co-application of rtPA and bevacizumab, and fluid-gas (20 % SF6) exchange. Phakic patients underwent concomitant cataract surgery. Additional injections of bevacizumab were applied intravitreally 4 and 8 weeks postop.

RESULTS: Complete displacement of SMH from the fovea was achieved in 9 of 12 patients. Mean best-corrected visual acuity (BCVA) improved significantly from preop logMAR 1.9 (range 3.0-0.7) to logMAR 1.2 (range 3.0-0.3) at 4 weeks postop (p=0.01) and to logMAR 0.9 (range 1.6-0.2) at 12 weeks postop (p=0.006). Mean improvement of BCVA 4 weeks postop as compared to preop was logMAR 0.7 (range -0.2 to 2.3). Mean improvement of BCVA 12 weeks postop as compared to preop was logMAR 0.96 (range -0.3 to 2.8). Overall, at 12 weeks postop BCVA had improved in 10 patients, remained unchanged in one patient, and worsened in one patient.

CONCLUSION: PpV with subretinal co-application of rtPA and bevacizumab, and fluid-gas exchange effectively displaces SMH and improves visual acuity in most patients.