Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration

• Published in: Eye (London) Vol. 23; no. 6; pp. 1404 - 1410
• Main Authors: Sacu, S, Stifter, E, Vécsei-Marlovits, P V, Michels, S, Schütze, C, Prünte, C, Schmidt-Erfurth, U
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-06-2009; Nature Publishing Group
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Bevacizumab; Biological and medical sciences; clinical-study; Drug Therapy, Combination; Female; Humans; Immunologic Factors - therapeutic use; Intravitreal Injections; Laboratory Medicine; Macular Degeneration - complications; Male; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Ophthalmology; Outcome Assessment (Health Care); Pharmaceutical Sciences/Technology; Pilot Projects; Ranibizumab; Recombinant Proteins - therapeutic use; Retinal Hemorrhage - drug therapy; Retinal Hemorrhage - etiology; Retinopathies; Retrospective Studies; Surgery; Surgical Oncology; Tissue Plasminogen Activator - therapeutic use; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity; recombinant tissue plasminogen activator; gas; lucentis; subfoveal haemorrhage; avastin; Secondary; Retinopathy; Serine endopeptidases; Enzyme; Hemorrhage; t-Plasminogen activator; Peptidases; Eye disease; Clinical management; Hydrolases; Age related macular degeneration; Neovascularization; Ophthalmology
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2008.267

Background
To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy.
Methods
This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (
n
=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (
n
=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed.
Results
Mean baseline VA was 0.15±0.2 and 0.25±0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1±0.14;
P
=0.003), and a stabilization in group B (mean difference: +0.008±0.2;
P
=0.94). CRT decreased significantly by 70 
μ
m in group A (
P
=0.001) and by 84 
μ
m in group B (
P
=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm
2
and 19.1 mm
2
at baseline and 0.0 mm
2
and 2.0 mm
2
at month 4, respectively. The anti-VEGF treatmentrate was 1.6 in group A and 3.0 in group B.
Conclusion
In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.