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Outcomes of vitrectomy combined with subretinal tissue plasminogen activator injection for submacular hemorrhage associated with polypoidal choroidal vasculopathy

  • Clinical Investigation
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Abstract

Purpose

To examine the outcomes of vitrectomy with subretinal tissue plasminogen activator (tPA) injection and postoperative intravitreal antivascular endothelial growth factor (VEGF) injection for submacular hemorrhage (SMH) associated with polypoidal choroidal vasculopathy (PCV).

Study design

Retrospective, consecutive case series.

Methods

Patients who underwent vitrectomy for SMH associated with PCV and who were followed up for at least 12 months were included. Surgery consisted of vitrectomy with subretinal tPA and air tamponade. Postoperative intravitreal anti-VEGF was administered pro re nata. The following were examined: best-corrected visual acuity (BCVA) at baseline, at 1 month, and at the final visit; the percentage of patients requiring anti-VEGF postoperatively; and the number of injections administered.

Results

This study included 23 eyes of 23 patients (21 men, 2 women) with a mean age of 72.5 ± 9.0 years. The mean duration from disease onset to surgery was 9.0 ± 6.6 days. The mean maximum SMH size was 5.8 ± 4.8 disc diameters. The mean follow-up period was 33 ± 14 months. The BCVA was significantly improved when compared with baseline 1 month after surgery and at the final visit. Postoperative anti-VEGF was required for 91% of the eyes. In eyes that underwent anti-VEGF therapy until the final visit, the mean injection number was 4.1/year.

Conclusions

Vitrectomy with subretinal tPA and air tamponade improved visual acuity in patients with SMH associated with PCV. Postoperative intravitreal anti-VEGF injection maintained the improved BCVA throughout a mean period of 33 months.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Shuhei Kimura, Yuki Morizane, Mio Morizane Hosokawa, Yusuke Shiode, Shinichiro Doi, Mika Hosogi, Atsushi Fujiwara & Fumio Shiraga

  2. Kurashiki Medical Center, Okayama, Japan

    Toshio Okanouchi

  3. Inoue Eye Clinic, Okayama, Japan

    Yasushi Inoue

Authors
  1. Shuhei Kimura
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  2. Yuki Morizane
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  4. Yusuke Shiode
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  5. Shinichiro Doi
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  6. Mika Hosogi
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  7. Atsushi Fujiwara
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  8. Toshio Okanouchi
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  9. Yasushi Inoue
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  10. Fumio Shiraga
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Corresponding author

Correspondence to Yuki Morizane.

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Conflicts of interest

S Kimura, None; Y. Morizane, None; M. Morizane Hosokawa, None; Y. Shiode, None; S. Doi, None; M. Hosogi, None; A. Fujiwara, None; T. Okanouchi, None; Y. Inoue, None; F. Shiraga, None.

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Corresponding author: Yuki Morizane

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Kimura, S., Morizane, Y., Hosokawa, M.M. et al. Outcomes of vitrectomy combined with subretinal tissue plasminogen activator injection for submacular hemorrhage associated with polypoidal choroidal vasculopathy. Jpn J Ophthalmol 63, 382–388 (2019). https://doi.org/10.1007/s10384-019-00679-2

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