INTRAVITREAL VERSUS SUBRETINAL ADMINISTRATION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR COMBINED WITH GAS FOR ACUTE SUBMACULAR HEMORRHAGES DUE TO AGE-RELATED MACULAR DEGENERATION: An Exploratory Prospective Study

• Published in: Retina (Philadelphia, Pa.) Vol. 36; no. 5; pp. 914 - 925
• Main Authors: de Jong, Jan H, van Zeeburg, Elsbeth J T, Cereda, Matteo G, van Velthoven, Mirjam E J, Faridpooya, Koorosh, Vermeer, Koenraad A, van Meurs, Jan C
• Format: Journal Article
• Language: English
• Published: United States 01-05-2016
• Subjects: Acute Disease; Combined Modality Therapy; Endotamponade; Fibrinolytic Agents - administration & dosage; Fluorocarbons - administration & dosage; Humans; Injections, Intraocular; Intravitreal Injections; Prospective Studies; Recombinant Proteins - administration & dosage; Retinal Hemorrhage - diagnosis; Retinal Hemorrhage - etiology; Retinal Hemorrhage - physiopathology; Retinal Hemorrhage - therapy; Tissue Plasminogen Activator - administration & dosage; Tomography, Optical Coherence; Visual Acuity - physiology; Vitrectomy; Wet Macular Degeneration - complications; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - physiopathology; Wet Macular Degeneration - therapy
• ISSN: 0275-004X; 1539-2864
• DOI: 10.1097/IAE.0000000000000954

Current management of submacular hemorrhage (SMH) favors vitrectomy and gas with subretinal administration of recombinant tissue plasminogen activator (rtPA) over mere intravitreal rtPA injections and gas. In this study, we aimed to compare the effectiveness of both treatment modalities to displace submacular blood.
Twenty-four patients with SMH secondary to age-related macular degeneration were included. The SMH had to exist ≤14 days at time of surgery and SMH thickness had to be between 250 μm and 1,250 μm. Patients were randomized to either intravitreal injections of rtPA, perfluoropropane (C3F8) gas, and bevacizumab (n = 12) or vitrectomy with subretinal rtPA administration, intravitreal C3F8 gas, and bevacizumab (n = 12). The SMH volume change was measured on spectral domain optical coherence tomography postoperatively within a 2.5-mm cylinder centered at the fovea.
Median relative volume reduction of subretinal blood at 6 weeks postoperatively was 97% (95% confidence interval: 91-99%) in the intravitreal rtPA group and 100% (95-100%) in the subretinal rtPA group and did not differ significantly between groups (P = 0.56).
Both treatment modalities effectively displaced SMH in this exploratory clinical trial. To more definitely study the noninferiority of intravitreal rtPA with gas to subretinal rtPA, vitrectomy with gas, a larger clinical trial would be necessary.