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Short and long term effect of intravitreal tissue plasminogen activator in eyes with submacular hemorrhage

Kurz- und Langzeiteffekt von intravitrealem rTPA in Augen mit submakulärer Blutung

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Summary

Objective

To determine the effect and side effects of intravitreal rTPA in eyes with submacular hemorrhage.

Method

28 eyes with a history of sudden visual loss between 1 day and 4 weeks were included in the study. They received 50μ rTPA and 0.3–0.5cc SF6 intravitreally. Preand postoperatively functional, biomicroscopical, and echographical results were compared. The follow up period was 12 months.

Results

Mean visual acuity was 20/376 preoperatively (range LP to 20/25), 12/28 patients (43%) had quantitative function. One week after surgery mean visual acuity improved to 20/325 (LP to 20/25) and only 4/28 patients (14%) showed quantitative function. At the final examination mean visual acuity decreased to 20/428 and the number of eyes with quantitative vision increased to 9/28 (32%). 12 eyes (43%) showed a final functional benefit after the treatment.

5 eyes (17.8%) developed a severe recurrent hemorrhage. In 3 of those a correlation to partial or total vitreous separation cannot be excluded. One eye showed an inferior retinal detachment 6 weeks postoperatively potentially induced by a complete vitreous separation.

Conclusion

The removal of submacular hemorrhage by intravitreal rTPA is a minimal invasive surgery. The postoperative success rate of 50% visual improvement is statistically significant to preoperative values but the final results are worse than the results immediately after surgery. The effect seems to be temporary especially in cases where the underlying AMD in not treatable.

Zusammenfassung

In der vorliegenden Studie werden die Wirkung und Nebenwirkungen von intravitralen RTPA in Augen mit submakulärer Blutung untersucht.

Methode

28 Augen mit plötzlichem Sehverlust von 1 Tag bis 4 Wochen wurden in die Studie aufgenommen. Sie erhielten eine intravitreale Injektion mit 50μ rTPA und 0,3–0,5 ccSF6 Prä- und postoperativ wurden die funktioneilen, biomikroskopischen und echographischen Ergebnisse verglichen. Die Nachbeobachtungszeit betrug 1 Jahr.

Ergebnisse

Das mittlere Sehvermögen betrug präoperativ 20/376 (von LP bis 20/25), 12 von 28 Patienten (43%) hatten nur ein quantitatives Sehen (LP bis FZ). Eine Woche postoperativ verbesserte sich das durchschnittliche Sehvermögen auf 20/325 (LP bis 20/25) und nur 4 von 28 Patienten (14%) gaben ein quantitatives Sehen an. Bei der letzten Kontrolle sank der Visus im Durchschnitt auf 20/428 und die Zahl der Augen mit quantitativer Funktion stieg auf 9 von 28 (32%).

12 Patienten (43%) hatten zu diesem Zeitpunkt eine bessere Funktion als präoperativ.

In 5 Augen (17,8%) trat eine schwere Nachblutung auf; in 3 Fällen stand diese im zeitlichen Zusammenhang mit einer hinteren Glaskörperabhebung. Ein Patient entwickelte eine Netzhautabhebung in der unteren Hälfte 6 Wochen postoperativ, die möglicherweise auch durch eine Glaskörperabhebung induziert wurde.

Schlussfolgerung

Die Verdrängung von submakulären Blutungen durch intravitreales rTPA und Gas ist ein minimal-invasiver Eingriff. Die postoperative Visusverbesserung in 50% der Fälle ist statistisch signifikant. Die Ergebnisse am Ende der Nachbeobachtungszeit sind jedoch deutlich schlechter als die nach 1 Woche erhobenen. Der Effekt scheint eine vorübergehende Verbesserung zu bewirken besonders in Fällen, in denen die darunterliegende Pathologie nicht behandelbar ist.

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Authors and Affiliations

  1. Ophthalmologic Department, KA Rudolfstiftung, Vienna

    U. Stolba, S. Binder, I. Krebs & S. Brunner

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Stolba, U., Binder, S., Krebs, I. et al. Short and long term effect of intravitreal tissue plasminogen activator in eyes with submacular hemorrhage. Spektrum Augeheilkd 14, 262–267 (2000). https://doi.org/10.1007/BF03162829

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