フジワラ アツシ
  藤原 篤之
   所属   川崎医療福祉大学  リハビリテーション学部 視能療法学科
   職種   助教
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator.
掲載誌名 正式名:American journal of ophthalmology
略  称:Am J Ophthalmol
ISSNコード:18791891/00029394
掲載区分国外
巻・号・頁 159(4),683-689頁
著者・共著者 Kimura Shuhei, Morizane Yuki, Hosokawa Mio, Shiode Yusuke, Kawata Tetsuhiro, Doi Shinichiro, Matoba Ryo, Hosogi Mika, Fujiwara Atsushi, Inoue Yasushi, Shiraga Fumio
発行年月 2015/04
概要 PURPOSE:To evaluate vitrectomy with subretinal tissue plasminogen activator (t-PA) injection, and air tamponade, followed by intravitreal anti-vascular endothelial growth factor (VEGF) therapy for submacular hemorrhage in polypoidal choroidal vasculopathy (PCV).DESIGN:Prospective, interventional case series.METHODS:setting: Two clinics.PATIENTS:Fifteen eyes of 15 consecutive patients (mean age 72 ± 7 years) with submacular hemorrhage attributable to PCV.INCLUSION CRITERIA:PCV diagnosis with unorganized submacular hemorrhage greater than 500 μm thick.EXCLUSION CRITERIA:Submacular hemorrhage attributable to macular diseases (eg, high myopia, typical age-related macular degeneration, retinal angiomatous proliferation, and angioid streaks).INTERVENTION:Vitrectomy with 4000 IU t-PA injected subretinally and fluid/air exchange. Patients remained facedown for 3 days after surgery. Anti-VEGF drugs were administered as exudative changes required.MAIN OUTCOME MEASURES:Submacular hemorrhage displacement from the macula and changes in best-corrected visual acuities (BCVAs).RESULTS:Mean time from onset to surgery was 9.5 ± 4.5 (range, 5-21) days. Mean follow-up period was 9.4 ± 3.1 (range, 6-17) months. Surgery successfully displaced submacular hemorrhages from the macula in all eyes. Mean BCVA at baseline (0.98 ± 0.44) had improved significantly both 1 month after surgery (0.41 ± 0.25, P < .01) and at final visits (0.23 ± 0.25, P < .001). In all eyes, exudative retinal changes relapsed after surgery but were completely resolved by anti-VEGF injections. No complications occurred in any patients.CONCLUSION:Treating submacular hemorrhage with vitrectomy and subretinal t-PA injection, followed by intravitreal anti-VEGF therapy, is a promising strategy for improving visual acuity in PCV patients warranting further investigation.
DOI 10.1016/j.ajo.2014.12.020
PMID 25555798