INTRAVITREAL GAS INJECTION WITH/WITHOUT RTPA. A RANDOMIZED STUDY

Lars-O. Hattenbach (Frankfurt/M.)

Purpose: Recent studies have provided evidence that intravitreal injections of the fibrinolytic agent recombinant tissue plasminogen activator (rt-PA) and expansile gas may be effective in displacing submacular hemorrhages secondary to age-related macular degeneration. However, it has been suggested that the injection of gas alone may be equally effective. The objective of our study was to compare the efficacy of these therapeutic approaches.

Methods: In a prospective randomized study, 37 consecutive eyes of 37 patients with recent (£ 28 days) submacular hemorrhage secondary to age-related macular degeneration and severe visual loss were treated with intravitreal injections of rt-PA (50 µg) and sulfur hexafluoride (0.5 ml) or hexafluoride alone. The size of the subretinal hemorrhage ranged from 1/4 to 12 disc areas.

Results: Among those patients who received intravitreal injections of rt-PA and gas, best postoperative visual acuity compared with preoperative visual acuity was improved two or more Snellen lines in 36 % of cases. Of those patients who received gas alone, 17 % showed a comparable improvement. Subgroup analysis revealed that better visual recovery after intravitreous injection of gas was associated with a duration of hemorrhage < 7d. In one patient (rt-PA) a breakthrough vitreous hemorrhage was observed.

Discussion: Our findings suggest that both, intravitreal injections of rt-PA and sulfur hexafluoride or gas alone, are of value for an improved and accelerated visual recovery in ARMD patients with submacular hemorrhage. Intravitreal injections of gas alone appear to be less effective in patients with onset of hemorrhage > 7 days prior to therapy.


Back