Management of Acute Submacular Hemorrhage with Intravitreal Injection of Tenecteplase, Anti-vascular Endothelial Growth Factor and Gas
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Purpose: To evaluate the visual and anatomical outcomes for neovascular age-related macular degenerationwith submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelialgrowth factor (VEGF) and expansile gas. Methods: This study was a retrospective clinical case series following 25 eyes of 25 patients. All patients receiveda triple injection using 0.05 mL TNK (50 μg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visualacuity and central retinal thickness were analyzed. Results: The mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantlyfrom 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thicknessalso improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visualimprovement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied. Conclusions: A triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatmentof submacular hemorrhage secondary to neovascular age-related macular degeneration.
Abstract
Purpose: To evaluate the visual and anatomical outcomes for neovascular age-related macular degenerationwith submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelialgrowth factor (VEGF) and expansile gas. Methods: This study was a retrospective clinical case series following 25 eyes of 25 patients. All patients receiveda triple injection using 0.05 mL TNK (50 μg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visualacuity and central retinal thickness were analyzed. Results: The mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantlyfrom 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thicknessalso improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visualimprovement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied. Conclusions: A triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatmentof submacular hemorrhage secondary to neovascular age-related macular degeneration.
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