The role of pigment epithelial detachment in AMD with submacular hemorrhage treated with vitrectomy and subretinal co-application of rtPA and anti-VEGF
Purpose To assess the incidence of pigment epithelial detachment (PED) in age-related macular degeneration (AMD) with submacular hemorrhage (SMH) and its response to treatment with pars plana vitrectomy (ppV), subretinal co-application of recombinant tissue plasminogen activator (rtPA) and anti-VEGF...
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| creator | Treumer, F. Wienand, S. Purtskhvanidze, K. Roider, J. Hillenkamp, J. |
| description | Purpose
To assess the incidence of pigment epithelial detachment (PED) in age-related macular degeneration (AMD) with submacular hemorrhage (SMH) and its response to treatment with pars plana vitrectomy (ppV), subretinal co-application of recombinant tissue plasminogen activator (rtPA) and anti-VEGF, and an intravitreal gas tamponade.
Methods
Consecutive interventional case series of 132 eyes of 129 patients with neovascular AMD with SMH. All eyes underwent ppV with subretinal co-application of rtPA and bevacizumab followed by a gas tamponade. Postoperatively, two additional intravitreal anti-VEGF injections were applied monthly, followed by intravitreal anti-VEGF injections applied PRN thereafter. PEDs and SMHs were evaluated with SD-OCT pre- and postoperatively.
Results
Preoperatively, 88 of 132 (67%) eyes were examined by OCT, and in 81 of these eyes the RPE could be visualised. A PED was found in 74 (91%) eyes, and no PED was found in five (6%) eyes. Median height of preoperative PED was 503 μm (range 150–1242,
n
= 65) and reduced to 344 (
n
= 62) and 306 μm (
n
= 27) after 3 and 12 months respectively. Two eyes showed a pre-existing rip of the RPE. Postoperatively, a rip was documented in 12 of 128 (9%) eyes. Median height of SMH was 762 μm (range 217–1840), median diameter was 4.3 (1.5-15) disc diameter. A complete displacement of the SMH from the fovea was achieved in 112 of 129 (87%) eyes. Overall, median best-corrected logMAR visual acuity (BCVA) improved significantly from preoperative 1.6 (0.5–2.0,
n
= 132) to 1.0 (0.2–2.0) 3 (
n
= 132) and 12 months (
n
= 74) postoperatively. Excluding eyes with pre-existing macular scars (
n
= 22), BCVA 3 months postoperatively was 0.8. Height of PED or SMH did not correlate with postoperatively BCVA, while size of SMH showed a mild correlation (rho = 0.25,
p
= 0.005).
Conclusion
PpV with subretinal co-application of rtPA and bevacizumab and an intravitreal gas tamponade effectively displaces SMH and improves BCVA. Preoperatively, PED is found in the majority of eyes. Height of PED or SMH did not correlate with postoperatively BCVA. Tears of the RPE occur as frequently as in exudative AMD without SMH. |
| doi_str_mv | 10.1007/s00417-017-3620-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1876497307</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1899694648</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-8e633dc9b85cdffeffc2ab43b9fda42a30f83db311ae82c4b9b5c853de8126283</originalsourceid><addsrcrecordid>eNp1kctu1TAQhi0EoqeFB2CDLLFhY_AlF3t51BtIRbAoqDvLcSYnrpI42A6oT8Lr1mkKQkgsLMsz3_-Pxj9Crxh9xyit30dKC1YTmo-oOCX8CdqxQpSkpvzmKdrRmjMiBb85Qscx3tKMi5I9R0dcckmVVDv067oHHPwA2Hd4docRpoRhdqmHwZkBt5CM7R-qbsL7T2f4Z-7huDSjsctgAu5h9CH05gA4BTAJ2g354fLTJj_eYTO1qyJAclP2tJ6YeR6cNcn5aR0c0pf9A2Wm5Mi388uLF-hZZ4YILx_vE_T14vz69AO5-nz58XR_RayoeSISKiFaqxpZ2rbroOssN00hGtW1puBG0E6KthGMGZDcFo1qSitL0YJkvOJSnKC3m-8c_PcFYtKjixaGwUzgl6iZrKtC1YLWGX3zD3rrl5AXWimlKlVUxWrINsoGH2OATs_BjSbcaUb1mpreUtM5Nb2mpnnWvH50zt8K7R_F75gywDcg5tZ0gPDX6P-63gPGDaTb</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1899694648</pqid></control><display><type>article</type><title>The role of pigment epithelial detachment in AMD with submacular hemorrhage treated with vitrectomy and subretinal co-application of rtPA and anti-VEGF</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Treumer, F. ; Wienand, S. ; Purtskhvanidze, K. ; Roider, J. ; Hillenkamp, J.</creator><creatorcontrib>Treumer, F. ; Wienand, S. ; Purtskhvanidze, K. ; Roider, J. ; Hillenkamp, J.</creatorcontrib><description>Purpose
To assess the incidence of pigment epithelial detachment (PED) in age-related macular degeneration (AMD) with submacular hemorrhage (SMH) and its response to treatment with pars plana vitrectomy (ppV), subretinal co-application of recombinant tissue plasminogen activator (rtPA) and anti-VEGF, and an intravitreal gas tamponade.
Methods
Consecutive interventional case series of 132 eyes of 129 patients with neovascular AMD with SMH. All eyes underwent ppV with subretinal co-application of rtPA and bevacizumab followed by a gas tamponade. Postoperatively, two additional intravitreal anti-VEGF injections were applied monthly, followed by intravitreal anti-VEGF injections applied PRN thereafter. PEDs and SMHs were evaluated with SD-OCT pre- and postoperatively.
Results
Preoperatively, 88 of 132 (67%) eyes were examined by OCT, and in 81 of these eyes the RPE could be visualised. A PED was found in 74 (91%) eyes, and no PED was found in five (6%) eyes. Median height of preoperative PED was 503 μm (range 150–1242,
n
= 65) and reduced to 344 (
n
= 62) and 306 μm (
n
= 27) after 3 and 12 months respectively. Two eyes showed a pre-existing rip of the RPE. Postoperatively, a rip was documented in 12 of 128 (9%) eyes. Median height of SMH was 762 μm (range 217–1840), median diameter was 4.3 (1.5-15) disc diameter. A complete displacement of the SMH from the fovea was achieved in 112 of 129 (87%) eyes. Overall, median best-corrected logMAR visual acuity (BCVA) improved significantly from preoperative 1.6 (0.5–2.0,
n
= 132) to 1.0 (0.2–2.0) 3 (
n
= 132) and 12 months (
n
= 74) postoperatively. Excluding eyes with pre-existing macular scars (
n
= 22), BCVA 3 months postoperatively was 0.8. Height of PED or SMH did not correlate with postoperatively BCVA, while size of SMH showed a mild correlation (rho = 0.25,
p
= 0.005).
Conclusion
PpV with subretinal co-application of rtPA and bevacizumab and an intravitreal gas tamponade effectively displaces SMH and improves BCVA. Preoperatively, PED is found in the majority of eyes. Height of PED or SMH did not correlate with postoperatively BCVA. Tears of the RPE occur as frequently as in exudative AMD without SMH.</description><identifier>ISSN: 0721-832X</identifier><identifier>EISSN: 1435-702X</identifier><identifier>DOI: 10.1007/s00417-017-3620-2</identifier><identifier>PMID: 28280989</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acuity ; Age ; Aged ; Aged, 80 and over ; Angiogenesis Inhibitors - administration & dosage ; Bevacizumab ; Bevacizumab - administration & dosage ; Drug Therapy, Combination ; Endotamponade - methods ; Eye ; Female ; Fibrinolytic Agents - administration & dosage ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Hemorrhage ; Humans ; Immunotherapy ; Intravitreal Injections ; Macular degeneration ; Macular Degeneration - complications ; Macular Degeneration - diagnosis ; Macular Degeneration - therapy ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Monoclonal antibodies ; Ophthalmology ; Recombinant Proteins ; Retina ; Retinal Detachment - diagnosis ; Retinal Detachment - etiology ; Retinal Detachment - therapy ; Retinal Disorders ; Retinal Hemorrhage - diagnosis ; Retinal Hemorrhage - etiology ; Retinal Hemorrhage - therapy ; Retinal Pigment Epithelium - pathology ; Retrospective Studies ; t-Plasminogen activator ; Tamponade ; Tears ; Tissue Plasminogen Activator - administration & dosage ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular endothelial growth factor ; Visual Acuity ; Vitrectomy - methods</subject><ispartof>Graefe's archive for clinical and experimental ophthalmology, 2017-06, Vol.255 (6), p.1115-1123</ispartof><rights>Springer-Verlag Berlin Heidelberg 2017</rights><rights>Graefe's Archive for Clinical and Experimental Ophthalmology is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-8e633dc9b85cdffeffc2ab43b9fda42a30f83db311ae82c4b9b5c853de8126283</citedby><cites>FETCH-LOGICAL-c372t-8e633dc9b85cdffeffc2ab43b9fda42a30f83db311ae82c4b9b5c853de8126283</cites><orcidid>0000-0003-2664-7040</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00417-017-3620-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00417-017-3620-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28280989$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Treumer, F.</creatorcontrib><creatorcontrib>Wienand, S.</creatorcontrib><creatorcontrib>Purtskhvanidze, K.</creatorcontrib><creatorcontrib>Roider, J.</creatorcontrib><creatorcontrib>Hillenkamp, J.</creatorcontrib><title>The role of pigment epithelial detachment in AMD with submacular hemorrhage treated with vitrectomy and subretinal co-application of rtPA and anti-VEGF</title><title>Graefe's archive for clinical and experimental ophthalmology</title><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><description>Purpose
To assess the incidence of pigment epithelial detachment (PED) in age-related macular degeneration (AMD) with submacular hemorrhage (SMH) and its response to treatment with pars plana vitrectomy (ppV), subretinal co-application of recombinant tissue plasminogen activator (rtPA) and anti-VEGF, and an intravitreal gas tamponade.
Methods
Consecutive interventional case series of 132 eyes of 129 patients with neovascular AMD with SMH. All eyes underwent ppV with subretinal co-application of rtPA and bevacizumab followed by a gas tamponade. Postoperatively, two additional intravitreal anti-VEGF injections were applied monthly, followed by intravitreal anti-VEGF injections applied PRN thereafter. PEDs and SMHs were evaluated with SD-OCT pre- and postoperatively.
Results
Preoperatively, 88 of 132 (67%) eyes were examined by OCT, and in 81 of these eyes the RPE could be visualised. A PED was found in 74 (91%) eyes, and no PED was found in five (6%) eyes. Median height of preoperative PED was 503 μm (range 150–1242,
n
= 65) and reduced to 344 (
n
= 62) and 306 μm (
n
= 27) after 3 and 12 months respectively. Two eyes showed a pre-existing rip of the RPE. Postoperatively, a rip was documented in 12 of 128 (9%) eyes. Median height of SMH was 762 μm (range 217–1840), median diameter was 4.3 (1.5-15) disc diameter. A complete displacement of the SMH from the fovea was achieved in 112 of 129 (87%) eyes. Overall, median best-corrected logMAR visual acuity (BCVA) improved significantly from preoperative 1.6 (0.5–2.0,
n
= 132) to 1.0 (0.2–2.0) 3 (
n
= 132) and 12 months (
n
= 74) postoperatively. Excluding eyes with pre-existing macular scars (
n
= 22), BCVA 3 months postoperatively was 0.8. Height of PED or SMH did not correlate with postoperatively BCVA, while size of SMH showed a mild correlation (rho = 0.25,
p
= 0.005).
Conclusion
PpV with subretinal co-application of rtPA and bevacizumab and an intravitreal gas tamponade effectively displaces SMH and improves BCVA. Preoperatively, PED is found in the majority of eyes. Height of PED or SMH did not correlate with postoperatively BCVA. Tears of the RPE occur as frequently as in exudative AMD without SMH.</description><subject>Acuity</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiogenesis Inhibitors - administration & dosage</subject><subject>Bevacizumab</subject><subject>Bevacizumab - administration & dosage</subject><subject>Drug Therapy, Combination</subject><subject>Endotamponade - methods</subject><subject>Eye</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fluorescein Angiography</subject><subject>Follow-Up Studies</subject><subject>Fundus Oculi</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Immunotherapy</subject><subject>Intravitreal Injections</subject><subject>Macular degeneration</subject><subject>Macular Degeneration - complications</subject><subject>Macular Degeneration - diagnosis</subject><subject>Macular Degeneration - therapy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies</subject><subject>Ophthalmology</subject><subject>Recombinant Proteins</subject><subject>Retina</subject><subject>Retinal Detachment - diagnosis</subject><subject>Retinal Detachment - etiology</subject><subject>Retinal Detachment - therapy</subject><subject>Retinal Disorders</subject><subject>Retinal Hemorrhage - diagnosis</subject><subject>Retinal Hemorrhage - etiology</subject><subject>Retinal Hemorrhage - therapy</subject><subject>Retinal Pigment Epithelium - pathology</subject><subject>Retrospective Studies</subject><subject>t-Plasminogen activator</subject><subject>Tamponade</subject><subject>Tears</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tomography, Optical Coherence</subject><subject>Treatment Outcome</subject><subject>Vascular endothelial growth factor</subject><subject>Visual Acuity</subject><subject>Vitrectomy - methods</subject><issn>0721-832X</issn><issn>1435-702X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kctu1TAQhi0EoqeFB2CDLLFhY_AlF3t51BtIRbAoqDvLcSYnrpI42A6oT8Lr1mkKQkgsLMsz3_-Pxj9Crxh9xyit30dKC1YTmo-oOCX8CdqxQpSkpvzmKdrRmjMiBb85Qscx3tKMi5I9R0dcckmVVDv067oHHPwA2Hd4docRpoRhdqmHwZkBt5CM7R-qbsL7T2f4Z-7huDSjsctgAu5h9CH05gA4BTAJ2g354fLTJj_eYTO1qyJAclP2tJ6YeR6cNcn5aR0c0pf9A2Wm5Mi388uLF-hZZ4YILx_vE_T14vz69AO5-nz58XR_RayoeSISKiFaqxpZ2rbroOssN00hGtW1puBG0E6KthGMGZDcFo1qSitL0YJkvOJSnKC3m-8c_PcFYtKjixaGwUzgl6iZrKtC1YLWGX3zD3rrl5AXWimlKlVUxWrINsoGH2OATs_BjSbcaUb1mpreUtM5Nb2mpnnWvH50zt8K7R_F75gywDcg5tZ0gPDX6P-63gPGDaTb</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Treumer, F.</creator><creator>Wienand, S.</creator><creator>Purtskhvanidze, K.</creator><creator>Roider, J.</creator><creator>Hillenkamp, J.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2664-7040</orcidid></search><sort><creationdate>20170601</creationdate><title>The role of pigment epithelial detachment in AMD with submacular hemorrhage treated with vitrectomy and subretinal co-application of rtPA and anti-VEGF</title><author>Treumer, F. ; Wienand, S. ; Purtskhvanidze, K. ; Roider, J. ; Hillenkamp, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-8e633dc9b85cdffeffc2ab43b9fda42a30f83db311ae82c4b9b5c853de8126283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acuity</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiogenesis Inhibitors - administration & dosage</topic><topic>Bevacizumab</topic><topic>Bevacizumab - administration & dosage</topic><topic>Drug Therapy, Combination</topic><topic>Endotamponade - methods</topic><topic>Eye</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fluorescein Angiography</topic><topic>Follow-Up Studies</topic><topic>Fundus Oculi</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Immunotherapy</topic><topic>Intravitreal Injections</topic><topic>Macular degeneration</topic><topic>Macular Degeneration - complications</topic><topic>Macular Degeneration - diagnosis</topic><topic>Macular Degeneration - therapy</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies</topic><topic>Ophthalmology</topic><topic>Recombinant Proteins</topic><topic>Retina</topic><topic>Retinal Detachment - diagnosis</topic><topic>Retinal Detachment - etiology</topic><topic>Retinal Detachment - therapy</topic><topic>Retinal Disorders</topic><topic>Retinal Hemorrhage - diagnosis</topic><topic>Retinal Hemorrhage - etiology</topic><topic>Retinal Hemorrhage - therapy</topic><topic>Retinal Pigment Epithelium - pathology</topic><topic>Retrospective Studies</topic><topic>t-Plasminogen activator</topic><topic>Tamponade</topic><topic>Tears</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tomography, Optical Coherence</topic><topic>Treatment Outcome</topic><topic>Vascular endothelial growth factor</topic><topic>Visual Acuity</topic><topic>Vitrectomy - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Treumer, F.</creatorcontrib><creatorcontrib>Wienand, S.</creatorcontrib><creatorcontrib>Purtskhvanidze, K.</creatorcontrib><creatorcontrib>Roider, J.</creatorcontrib><creatorcontrib>Hillenkamp, J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Treumer, F.</au><au>Wienand, S.</au><au>Purtskhvanidze, K.</au><au>Roider, J.</au><au>Hillenkamp, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The role of pigment epithelial detachment in AMD with submacular hemorrhage treated with vitrectomy and subretinal co-application of rtPA and anti-VEGF</atitle><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle><stitle>Graefes Arch Clin Exp Ophthalmol</stitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>255</volume><issue>6</issue><spage>1115</spage><epage>1123</epage><pages>1115-1123</pages><issn>0721-832X</issn><eissn>1435-702X</eissn><abstract>Purpose
To assess the incidence of pigment epithelial detachment (PED) in age-related macular degeneration (AMD) with submacular hemorrhage (SMH) and its response to treatment with pars plana vitrectomy (ppV), subretinal co-application of recombinant tissue plasminogen activator (rtPA) and anti-VEGF, and an intravitreal gas tamponade.
Methods
Consecutive interventional case series of 132 eyes of 129 patients with neovascular AMD with SMH. All eyes underwent ppV with subretinal co-application of rtPA and bevacizumab followed by a gas tamponade. Postoperatively, two additional intravitreal anti-VEGF injections were applied monthly, followed by intravitreal anti-VEGF injections applied PRN thereafter. PEDs and SMHs were evaluated with SD-OCT pre- and postoperatively.
Results
Preoperatively, 88 of 132 (67%) eyes were examined by OCT, and in 81 of these eyes the RPE could be visualised. A PED was found in 74 (91%) eyes, and no PED was found in five (6%) eyes. Median height of preoperative PED was 503 μm (range 150–1242,
n
= 65) and reduced to 344 (
n
= 62) and 306 μm (
n
= 27) after 3 and 12 months respectively. Two eyes showed a pre-existing rip of the RPE. Postoperatively, a rip was documented in 12 of 128 (9%) eyes. Median height of SMH was 762 μm (range 217–1840), median diameter was 4.3 (1.5-15) disc diameter. A complete displacement of the SMH from the fovea was achieved in 112 of 129 (87%) eyes. Overall, median best-corrected logMAR visual acuity (BCVA) improved significantly from preoperative 1.6 (0.5–2.0,
n
= 132) to 1.0 (0.2–2.0) 3 (
n
= 132) and 12 months (
n
= 74) postoperatively. Excluding eyes with pre-existing macular scars (
n
= 22), BCVA 3 months postoperatively was 0.8. Height of PED or SMH did not correlate with postoperatively BCVA, while size of SMH showed a mild correlation (rho = 0.25,
p
= 0.005).
Conclusion
PpV with subretinal co-application of rtPA and bevacizumab and an intravitreal gas tamponade effectively displaces SMH and improves BCVA. Preoperatively, PED is found in the majority of eyes. Height of PED or SMH did not correlate with postoperatively BCVA. Tears of the RPE occur as frequently as in exudative AMD without SMH.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28280989</pmid><doi>10.1007/s00417-017-3620-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2664-7040</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0721-832X |
| ispartof | Graefe's archive for clinical and experimental ophthalmology, 2017-06, Vol.255 (6), p.1115-1123 |
| issn | 0721-832X 1435-702X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1876497307 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Acuity Age Aged Aged, 80 and over Angiogenesis Inhibitors - administration & dosage Bevacizumab Bevacizumab - administration & dosage Drug Therapy, Combination Endotamponade - methods Eye Female Fibrinolytic Agents - administration & dosage Fluorescein Angiography Follow-Up Studies Fundus Oculi Hemorrhage Humans Immunotherapy Intravitreal Injections Macular degeneration Macular Degeneration - complications Macular Degeneration - diagnosis Macular Degeneration - therapy Male Medicine Medicine & Public Health Middle Aged Monoclonal antibodies Ophthalmology Recombinant Proteins Retina Retinal Detachment - diagnosis Retinal Detachment - etiology Retinal Detachment - therapy Retinal Disorders Retinal Hemorrhage - diagnosis Retinal Hemorrhage - etiology Retinal Hemorrhage - therapy Retinal Pigment Epithelium - pathology Retrospective Studies t-Plasminogen activator Tamponade Tears Tissue Plasminogen Activator - administration & dosage Tomography, Optical Coherence Treatment Outcome Vascular endothelial growth factor Visual Acuity Vitrectomy - methods |
| title | The role of pigment epithelial detachment in AMD with submacular hemorrhage treated with vitrectomy and subretinal co-application of rtPA and anti-VEGF |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-12T02%3A49%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20role%20of%20pigment%20epithelial%20detachment%20in%20AMD%20with%20submacular%20hemorrhage%20treated%20with%20vitrectomy%20and%20subretinal%20co-application%20of%20rtPA%20and%20anti-VEGF&rft.jtitle=Graefe's%20archive%20for%20clinical%20and%20experimental%20ophthalmology&rft.au=Treumer,%20F.&rft.date=2017-06-01&rft.volume=255&rft.issue=6&rft.spage=1115&rft.epage=1123&rft.pages=1115-1123&rft.issn=0721-832X&rft.eissn=1435-702X&rft_id=info:doi/10.1007/s00417-017-3620-2&rft_dat=%3Cproquest_cross%3E1899694648%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1899694648&rft_id=info:pmid/28280989&rfr_iscdi=true |