Subretinal Co-application of rtPA and Bevacizumab for Neovascular AMD with Submacular Hemorrhage
Exudative age-related macular degeneration (AMD) is the most frequent cause of acute submacular hemorrhage (SMH). Without treatment, the formation of a macular scar with poor visual function is the usual outcome. While several surgical treatment approaches have been proposed to date, there is no general consensus regarding optimal treatment of acute SMH. Vitrectomy with subretinal co-application of recombinant tissue plasminogen activator (rtPA) and bevacizumab followed by a gas tamponade is a new approach which has shown promising functional results in clinical studies. The aim of the co-application of rtPA and bevacizumab is to simultaneously displace submacular hemorrhage from the fovea and to reduce choroidal new vessel activity effectively. Experimental laboratory studies have shown that neither rtPA nor rtPA-generated plasmin cleaves or functionally inactivates bevacizumab. The experimental results show that both substances are compatible and may be co-applied in surgery.
KeywordsAge-related macular degeneration Recombinant tissue plasminogen activator Bevacizumab Submacular hemorrhage Vitrectomy Subretinal co-application Vascular endothelial growth factor Choroidal neovascularization Anticoagulation
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