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Kombinierte intravitreale Injektion von Bevacizumab und SF6-Gas bei AMD-assoziierter, submakulärer Hämorrhagie

Combined intravitreal injection of bevacizumab and SF6 gas for treatment of submacular hemorrhage secondary to age-related macular degeneration

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Zusammenfassung

Hintergrund

Die vorliegende Fallserie untersucht die Ergebnisse nach kombinierter intravitrealer Applikation von Bevacizumab und Schwefelhexafluorid (SF6) zur Behandlung der AMD-assoziierten, submakulären Hämorrhagie.

Material und Methoden

Es wurden 10 Augen von 10 Patienten mit akuter subfovealer Hämorrhagie infolge einer altersbedingten Makuladegeneration (AMD) in die Studie eingeschlossen. Die submakulären Einblutungen waren zwischen 1 und maximal 4 Wochen alt (Median 1, Mittelwert 1,5 Wochen), die Größen des Blutungsareals variierten zwischen 0,85 und 21,7 mm2 (Median 6,6 mm2, Mittelwert 9,5 mm2 ±8,12). Alle Patienten erhielten eine kombinierte einmalige intravitreale Gabe von 1,25 mg Bevacizumab und 0,3 ml SF6. Die Kontrolle fand 4 Wochen nach der Operation statt. Abhängig vom Befund wurde eine weiterführende Anti-VEGF-Therapie durchgeführt.

Ergebnisse

Vier Wochen postoperativ zeigte sich ein Visusanstieg von 3 oder mehr Zeilen in 6 Augen (60%), 3 Patienten blieben stabil (30%) und ein Visusverlust von 3 oder mehr Zeilen wurde in einem Fall festgestellt (10%). In 8 Fällen (80%) konnte eine Dislokation des subretinalen Blutes nach inferior beobachtet werden. Neun von 10 Patienten erhielten im weiteren Verlauf (durchschnittlich 11,7 Monate) intravitreale Injektionen mit VEGF-Inhibitoren. Im Wilcoxon-Test für verbundene Stichproben war der Visusanstieg statistisch signifikant (p=0,05).

Schlussfolgerung

Unsere Ergebnisse legen nahe, dass die kombinierte Gabe von Bevacizumab und SF6-Gas bei AMD-assoziierten submakulären Hämorrhagien die Visusprognose verbessern kann. Wichtige Voraussetzung ist die weiterführende Behandlung der zugrunde liegenden choroidalen Neovaskularisation (CNV).

Abstract

Objective

To investigate the efficacy of intravitreous bevacizumab and sulphur hexafluoride (SF6) for treating submacular hemorrhage secondary to age-related macular degeneration (ARMD).

Methods

Ten eyes of 10 patients (mean age 78.4 years, ±6.5) with recent (range 1–4 weeks, median 1.0, mean 1.5) subfoveal hemorrhage secondary to ARMD were included in this study. The size of the subretinal hemorrhage ranged from 0.85 to 21.7 mm2 (median 6.6 mm2, mean 9.5 mm2, ±8.12). All patients received combined intravitreous injections of 1.25 mg bevacizumab and 0.3 ml SF6. Follow-up visits were done 4 weeks after treatment. Depending on the ophthalmologic findings, further treatment with antivascular endothelial growth factor (anti-VEGF) injections was planned.

Results

Visual acuity improved three or more Snellen lines in six eyes (60%), remained stable in three (30%), and worsened by three or more lines in one eye (10%). Overall, displacement of blood was achieved in eight eyes (80%). In the following months, nine eyes received further injections with VEGF inhibitors. The Wilcoxon paired sample test revealed significant improvement of visual acuity in our patients (p=0.05).

Conclusions

Our findings suggest that combined intravitreous injections of bevacizumab and SF6 have the potential to improve visual outcome in patients with subretinal hemorrhage secondary to ARMD. However, further treatment of the underlying choroidal neovascularization is mandatory.

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  1. Augenklinik des Klinikums Ludwigshafen, Bremserstraße 79, 68063, Ludwigshafen, Deutschland

    F. Höhn FEBO, A. Mirshahi & L.-O. Hattenbach

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  1. F. Höhn FEBO
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  2. A. Mirshahi
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  3. L.-O. Hattenbach
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Correspondence to F. Höhn FEBO.

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Höhn, F., Mirshahi, A. & Hattenbach, LO. Kombinierte intravitreale Injektion von Bevacizumab und SF6-Gas bei AMD-assoziierter, submakulärer Hämorrhagie. Ophthalmologe 107, 328–332 (2010). https://doi.org/10.1007/s00347-009-2004-3

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