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VISUAL AND ANATOMICAL OUTCOMES AFTER VITRECTOMY WITH SUBRETINAL TISSUE PLASMINOGEN ACTIVATOR INJECTION IN PATIENTS
David Gallagher1, David Hurley, Luke O'Brien
1Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.
Purpose:
Submacular hemorrhages (SMHs) are most commonly associated with wet age-related macular degeneration and their size and duration are strong prognostic factors for visual outcome. The aim of this audit was to evaluate outcomes of direct injection of submacular tissue plasminogen activator into these lesions during pars plana vitrectomy.
Methods:
All patients presenting to the Mater Misericordiae Hospital from January 2017 to December 2019 with large submacular hemorrhages secondary to wet age-related macular degeneration who underwent this treatment were included for review. All 10 patients underwent complete pars plana vitrectomy, injection of 0.2 mL (50 μg) of subretinal tissue plasminogen activator, and air tamponade. Preoperative and postoperative evaluations included VA testing, optical coherence tomography, and slit lamp examination.
Results:
Eight patients (80%) showed improvement of their VA, with four patients achieving a VA of ≤0.4 LogMAR (20/50). Six patients had a total clearing of the macular hemorrhage, with a further two patients having subtotal clearance. One patient subsequently developed a retinal detachment requiring oil tamponade.
Conclusion:
Submacular hemorrhage secondary to wet age-related macular degeneration is a sight threatening event with a varied prognosis, but in most cases, vitrectomy with subretinal tissue plasminogen activator injection results in improved anatomical and visual outcomes.
