藤原 篤之
   Department     ,
   Position  
Article types 原著
Language English
Peer review Peer reviewed
Title Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator.
Journal Formal name:American journal of ophthalmology
Abbreviation:Am J Ophthalmol
ISSN code:18791891/00029394
Domestic / ForeginForegin
Volume, Issue, Page 159(4),683-689頁
Author and coauthor Kimura Shuhei, Morizane Yuki, Hosokawa Mio, Shiode Yusuke, Kawata Tetsuhiro, Doi Shinichiro, Matoba Ryo, Hosogi Mika, Fujiwara Atsushi, Inoue Yasushi, Shiraga Fumio
Publication date 2015/04
Summary 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