Submacular Hemorrhages and Treatment Study

Accumulation of blood between the neurosensory retina and the retinal pigment epithelium (RPE), known as submacular haemorrhages (SMH), is a significant cause of sudden vision loss. In particular, if the SMH related to CNVM in neovascular age-related macular degeneration (AMD) is large and very thick, the prognosis is poor if left untreated or delayed in treatment. Surgical removal of the SMH through small or large retinal incisions, macular translocation, and RPE choroid grafts are the treatment methods used in the long-standing SMH.

A recent study published in Beyoglu Eye Journal has concluded that administering subretinal bevacizumab and subretinal tissue plasminogen activator (tPA) effectively removes subretinal hemorrhage under the fovea. It is necessary to continue intravitreal anti-VEGF treatment, as choroidal neovascular membrane activity continues after surgery.

The patients underwent pars plana vitrectomy (PPV) with simultaneous subretinal tPA and subretinal bevacizumab with 18% SF6 tamponade. Researchers evaluated the anatomical and functional results of the patients before surgery and at the 1st, 6th, and 12th months after surgery, additional treatments, and complications following PPV.

Key Findings

• Eight eyes of eight patients with a mean age of 72 were included in the study.
• The mean time from the onset of the symptoms to management was 5.13±1.88 days.
• The patients’ mean best-corrected visual acuity (BCVA) was 2.23±0.14 logMAR at baseline.
• There was a significant increase in mean BCVA at the 1st, 6th, and 12th months to 1.68±0.47 logMAR, 1.58±0.49 logMAR, and 1.51±0.58 logMAR, respectively.
• At baseline, the mean central foveal thickness (CFT) in measurable patients was 836.8±627.02 μm.
• There was a significant decrease in mean CFT to 370.13±66.13 μm, 373.38±78.33, and 367.75±116.43 μm in the 1st, 6th, and 12th month, respectively.
• At baseline, the maximum measurable subretinal hemorrhage height was 814.2±556.45 μm.
• The mean number of anti-VEGFs performed for 12 months after surgery was 4.13±2.1.
• At month 12, the ellipsoid zone could not be detected in 6 patients.

The present study aimed to evaluate the outcomes of simultaneously administering bevacizumab and subretinal tPA to patients with SMH secondary to neovascular AMD with functional and anatomical results in 12-month follow-ups, and the results showed significant improvements in both BCVA and CFT decrease at all follow-up visits.

Repeated injections are necessary to maintain the increased visual acuity, and there was no correlation between BCVA and CFT at month 12 with the maximal SMH height or the maximum lateral width of SMH.

Reference

Limon U et al. Efficacy of Simultaneous Application of Subretinal Tissue Plasminogen Activator and Bevacizumab for Submacular Hemorrhages. Beyoglu Eye J. 2023;8(3):198-207. Published 2023 Sep 13.