Par plana vitrectomy, ubretinal injection of tiue plaminogen activator, and fluid–ga exchange for diplacement of thick ubmacular hemorrhage in age-related macular degeneration

PURPOE: To evaluate a new procedure for diplacement of large, thick ubmacular hemorrhage in patient with age-related macular degeneration. METHOD: Retropective review of 11 eye of 11 patient with age-related macular degeneration and thick ubmacular hemorrhage (defined a cauing retinal elevation detectable on tereo fundu photograph) treated with vitrectomy, ubretinal injection of tiue plaminogen activator (25 or 50 μg), and fluid–ga exchange with potoperative prone poitioning. Outcome meaure included diplacement of hemorrhage from the fovea, bet potoperative viual acuity, and final potoperative viual acuity. REULT: In the 11 affected eye of 11 patient (even men and four women; mean age, 76 year), preoperative viual acuity ranged from 20/200 to hand motion. With urgery, ubretinal hemorrhage wa diplaced from the fovea in all 11 cae. Mean potoperative follow-up wa 6.5 month (range, 1 to 15 month). Bet potoperative viual acuity varied from 20/30 to 5/200, with improvement in nine (82%) cae and no change in two cae. Eight eye (73%) meaured 20/200 or better, with four of thee eye (36%) 20/80 or better. Final potoperative viual acuity ranged from 20/70 to light perception, with improvement in eight (73%) cae, no change in one cae, and worening in two cae. A tatitically ignificant difference wa found between preoperative and bet potoperative viual acuity (P = .004) but not between preoperative and final viual acuity (P = .16). Hemorrhage recurred in three (27%) eye, cauing evere viual lo in one eye. CONCLUION: Thi technique diplace ubmacular hemorrhage from the fovea and can improve viion in patient with age-related macular degeneration. However, recurrence of hemorrhage occurred in 27% of eye and caued evere viual lo in one eye. A randomized, propective clinical trial i neceary to determine the efficacy of thi technique in comparion with other propoed treatment.