Efficacy of Simultaneous Application of Subretinal Tissue Plasminogen Activator and Bevacizumab for Submacular...

The aim of the study was to evaluate the patients who received simultaneous subretinal tissue plasminogen activator (tPA) and bevacizumab for submacular hemorrhages secondary to neovascular age-related macular degeneration.

This retrospective study included patients who underwent pars plana vitrectomy (PPV) with simultaneous subretinal tPA and subretinal bevacizumab with 18% SF6 tamponade. Anatomical and functional results of the patients before surgery and at the 1^st, 6^th, and 12^th months after surgery, additional treatments, and complications after PPV were evaluated.

Eight eyes of eight patients were included in the study. The mean age of the patients was 72.38±92.3. The mean time from the onset of symptoms to treatment was 5.13±1.88 days. The patients' mean best-corrected visual acuity (BCVA) was 2.23±0.14 logMAR at baseline. Mean BCVA increased significantly at 1^st, 6^th, and 12^th months to 1.68±0.47 logMAR, 1.58±0.49 logMAR, and 1.51±0.58 logMAR, respectively (p=0.001 at all). The mean central foveal thickness (CFT) in measurable patients was 836.8±627.02 μm at baseline. Mean CFT decreased significantly to 370.13±66.13 μm in the 1^st month, 373.38±78.33 μm in the 6th month, and 367.75±116.43 μm in the 12^th month (p<0.05). The maximum measurable subretinal hemorrhage height at baseline was 814.2±556.45 μm. The mean number of anti-VEGFs performed for 12 months after surgery was 4.13±2.1. At month 12, the ellipsoid zone could not be detected in 6 (75%) patients.

Administration of subretinal bevacizumab and subretinal tPA effectively removes subretinal hemorrhage under the fovea. Intravitreal anti-VEGF treatment must be continued, as choroidal neovascular membrane activity continues after surgery.