1
|
Confalonieri F, Ferraro V, Barone G, Di Maria A, Petrovski BÉ, Vallejo Garcia JL, Randazzo A, Vinciguerra P, Lumi X, Petrovski G. Outcomes in the Treatment of Subretinal Macular Hemorrhage Secondary to Age-Related Macular Degeneration: A Systematic Review. J Clin Med 2024; 13:367. [PMID: 38256501 PMCID: PMC10816885 DOI: 10.3390/jcm13020367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Subretinal macular hemorrhage (SRMH) secondary to age-related macular degeneration (AMD) is a relatively rare condition in ophthalmology characterized by blood collection between the neurosensory retina and the retinal pigment epithelium (RPE). Without prompt treatment, visual prognosis is poor. A plethora of treatment approaches have been tried over the past years ranging from intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy to direct subretinal surgery, with no conclusive superiority of one over the other. Materials and Methods: We conducted a systematic review of the outcomes and treatment modalities of SRMH from inception to 14 June 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The level of evidence was assessed for all included articles according to the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: A total of 2745 articles were initially extracted, out of which 1654 articles were obtained after duplicates were removed and their abstracts screened. A total of 155 articles were included for full-text review. Finally, 81 articles remained that fulfilled the inclusion criteria. Conclusions: Even though there are solid results supporting a variety of treatments for SRMH, the best treatment modality has still not been conclusively demonstrated and further research is needed.
Collapse
Affiliation(s)
- Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Gianmaria Barone
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Beáta Éva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
| | - Josè Luis Vallejo Garcia
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandro Randazzo
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Xhevat Lumi
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
- Eye Hospital, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
- UKLONetwork, University St. Kliment Ohridski-Bitola, 7000 Bitola, North Macedonia
| |
Collapse
|
2
|
Abdulaal M, Donkor R, Robertson J, Lewis S, Miller DG, Schartman J, Platt S, Coney JM. Early surgical displacement of submacular hemorrhage without tissue plasminogen activator use: one-year outcomes. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00310-1. [PMID: 37925165 DOI: 10.1016/j.jcjo.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study evaluated changes in best-corrected visual acuity and submacular hemorrhage (SMH) resolution in eyes after a single rapid subretinal displacement surgery using subretinal balanced saline solution and sterile air without tissue plasminogen activator (tPA). DESIGN A retrospective comparative interventional analysis. PARTICIPANTS Twenty-six eyes with thick SMH who underwent pars plana vitrectomy and subretinal fluid displacement without tPA from 2015 and 2021 and at least 1-year of follow-up. METHODS Surgical intervention included a standard small-gauge pars plana vitrectomy with subretinal displacement using balanced saline solution with subretinal sterile air and partial gas-air fluid exchange. Main outcome measures included degree of subfoveal SMH displacement, best and final postoperative visual acuities, and adverse events. Snellen acuity was converted to logMARs for statistical analysis. RESULTS The most common etiology associated with thick SMH (92.3%) was neovascular age-related macular degeneration. Within 1 month postoperatively, 21 patients (80.8%) saw complete subfoveal blood displacement. Most of the SMH surgical displacements were done within 1 week of presenting symptoms. Average preoperative duration of SMH was 3.60 ± 2.78 days (range, 1-12 days). Mean logMAR best-corrected visual acuity improved from 1.63 ± 0.58 (Snellen 20/800 baseline) to 0.90 ± 0.42 letters (Snellen 20/160) at last follow-up (p = 0.001). This study's visual acuity improvement is comparable with that of prior studies using tPA. Early postoperative complications included 1 retinal detachment, 1 vitreous hemorrhage, and 1 macular hole. CONCLUSION Rapid surgery with subretinal balanced saline solution-sterile air injection without tPA was found to be effective for displacement of thick SMH with retinal function, visual acuity, and corneal refractive therapy improvement.
Collapse
Affiliation(s)
| | | | | | - Shawn Lewis
- Retina Associates of Cleveland, Beachwood, OH
| | | | | | - Sean Platt
- Retina Associates of Cleveland, Beachwood, OH
| | | |
Collapse
|
3
|
Tiosano A, Gal-Or O, Fradkin M, Elul R, Dotan A, Hadayer A, Brody J, Ehrlich R. Visual acuity outcome in patients with subretinal hemorrhage - office procedure vs. surgical treatment. Eur J Ophthalmol 2023; 33:506-513. [PMID: 35532042 DOI: 10.1177/11206721221098208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the effects of intravitreal injection of tissue plasminogen activator (tPA) and gas vs. pars plana vitrectomy (PPV) surgery as first-line treatment for subretinal hemorrhage. METHODS Retrospective study of 107 adults treated for subretinal hemorrhage at a tertiary hospital during 2008-2019; 51 received injection of tPA and gas and 56 underwent PPV. RESULTS No between-group differences were found in age and sex, medical history, use of anticoagulants or antiplatelets, history of ocular surgeries, and previous use of intravitreal anti-VEGF. Overall follow-up time was longer in the PPV group (median 4.9 vs 3.28 years, p = 0.005). The hemorrhage was displaced in a similar percentage of patients in the tPA-and-gas group (n = 40, 78.4%) and the PPV group (n = 45, 80.4%) (p = 0.816). Approximately 80% of patients in the tPA-and-gas group were able to forgo PPV surgery. Visual acuity (in LogMAR) was similar in the two groups prior to the diagnosis of subretinal hemorrhage but better in the tPA-and-gas group at the end of follow-up (p < 0.001). CONCLUSION Injection of gas and tPA can be done immediately following diagnosis of subretinal hemorrhage as an office procedure. Visual acuity outcome is good, with a high rate of blood displacement. About 20% of patients might require additional PPV as secondary intervention.
Collapse
Affiliation(s)
- Alon Tiosano
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Orly Gal-Or
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Maayan Fradkin
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Rotem Elul
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Adelson Faculty of Medicine, 42732Ariel University, Ariel, Israel
| | - Assaf Dotan
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Amir Hadayer
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Judith Brody
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Rita Ehrlich
- Department of Ophthalmology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Falavarjani KG, Anvari P, Shad E, Dehghan Niri MH, Sedaghat A, Abdi F, Parvaresh MM, Saeidian B, Gordiz A, Amirfarhangi Anbardan A. Intravitreal recombinant tPA before vitrectomy for diabetic tractional retinal detachment: A randomized controlled trial. Eur J Ophthalmol 2022; 32:3522-3526. [PMID: 35861974 DOI: 10.1177/11206721221116013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the effect of intravitreal recombinant tissue plasminogen activator (rt-PA) injection before vitrectomy on surgical facility and outcome in diabetic tractional retinal detachments (TRD). METHODS Prospective, randomized, interventional clinical trial. A total of 38 eyes with diabetic TRD were candidates for vitrectomy. Patients were randomized 1:1 to receive intravitreal rt-PA, five to seven days before vitrectomy or no injection. Intraoperative surgical facility and anatomic success at month 3 after surgery were assessed. RESULTS Mean patient age was 54.2 ± 9.4 years. There was no statistically significant difference between rt-PA and no injection groups with regard to anatomic success (89% versus 95%, respectively, P = 0.547) and best corrected visual acuity at 3 months (2.0 versus 2.1 logMAR, respectively, P = 0.840). However, surgical facility score was statistically significantly lower in rt-PA injection group compared to no injection group (4.1 ± 1.7, 5.8 ± 2.0, respectively, P = 0.007). CONCLUSIONS Vitrectomy for TRD was easier after preoperative rt-PA injection, without affecting the anatomic and visual outcomes.
Collapse
Affiliation(s)
- Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Pasha Anvari
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Esrafil Shad
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Dehghan Niri
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdi
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Parvaresh
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Behrouz Saeidian
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Arzhang Gordiz
- Eye Research Center, The Five Senses Health Institute, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Abdollah Amirfarhangi Anbardan
- Department of Cardiovascular Disease, 48492Hazrat-e Rasool General Hospital, 440827Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Sniatecki JJ, Ho-Yen G, Clarke B, Barbara R, Lash S, Papathomas T, Antonakis S, Gupta B. Treatment of submacular hemorrhage with tissue plasminogen activator and pneumatic displacement in age-related macular degeneration. Eur J Ophthalmol 2019; 31:643-648. [PMID: 31813290 DOI: 10.1177/1120672119891625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate visual and anatomic outcomes following pars plana vitrectomy and intravitreal or subretinal tissue plasminogen activator for submacular hemorrhage in patients with age-related macular degeneration. METHODS This was a retrospective study on patients with a minimum follow-up of 12 months undertaken at a tertiary referral center. Data collected include demographic details, visual and optical coherence tomography changes, surgical details, and complications. Surgical results were compared with patients who were age and lesion size matched and treated with anti-vascular endothelial growth factor injections alone. RESULTS There were 36 patients in surgical and 18 patients in control group. Patients in surgical arm had pars plana vitrectomy, intravitreal tissue plasminogen activator with air 24 (67%), 6 (16%) with C3F8 gas, 1 (3%) with SF6 gas, 4 (11%) subretinal tissue plasminogen activator with air, and 1 (3%) with C2F6 as post-operative tamponade. Mean LogMAR in tissue plasminogen activator group at baseline was 1.56, and it was improved at all time points 1.06 at 1 month (p < 0.05), 0.91 at 6 months (p < 0.05), and 1.07 at 1 year (p < 0.05). Mean best corrected visual acuity in control group at baseline was 1.22LogMAR with no significant improvement at any time points: 1 month (1.27), 6 months (1.35), and 12 months (1.36). Complications included retinal detachment 5%, vitreous hemorrhage 7.5%, and cataract 19%. CONCLUSION Pars plana vitrectomy with intravitreal (or subretinal) tissue plasminogen activator and pneumatic displacement can offer better outcome in comparison to anti-vascular endothelial growth factor alone in patients with submacular hemorrhage secondary to age-related macular degeneration.
Collapse
Affiliation(s)
| | - Gregory Ho-Yen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Benjamin Clarke
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ramez Barbara
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Lash
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas Papathomas
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Bhaskar Gupta
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
6
|
Erdogan G, Kirmaci A, Perente I, Artunay O. Gravitational displacement of submacular haemorrhage in patients with age-related macular disease. Eye (Lond) 2019; 34:1136-1141. [PMID: 31792350 DOI: 10.1038/s41433-019-0720-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 10/10/2019] [Accepted: 10/18/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate the efficacy of gravitational displacement following vitrectomy for the patients with submacular haemorrhage (SMH) secondary to age-related macular degeneration (AMD). METHODS Retrospective, interventional series of nine consecutive AMD patients with SMH. All patients underwent pars plana vitrectomy (PPV) combined with subretinal tissue plasminogen activator (t-PA) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection without any tamponade. The patients were positioned according to the location and distribution of SMH postoperatively in order to provide the maximum gravitational force effect to displace. Outcome measures were the change in visual acuity, the displacement in SMH, and the occurrence of per- and postoperative complications. RESULTS Complete displacement of haemorrhage occurred in all patients postoperatively. The mean preoperative and postoperative best-corrected visual acuity (BCVA) at the last visit were 2.46 and 1.7 logMAR, respectively, after a mean follow-up of 10.4 months (Range: 3-18 months) (p = 0.045). The mean duration of haemorrhage was 15.3 days (range: 3-40 days). The recurrence of SMH was observed in two (22%) patients and there were no other postoperative complications. CONCLUSION Gravitational displacement following PPV combined with subretinal t-PA and intravitreal anti-VEGF injection can be considered as an effective surgical intervention in selected AMD patients with SMH.
Collapse
Affiliation(s)
- Gurkan Erdogan
- University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Asli Kirmaci
- University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Irfan Perente
- University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Artunay
- University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Ozkaya A, Erdogan G, Tarakcioglu HN. Submacular hemorrhage secondary to age-related macular degeneration managed with vitrectomy, subretinal injection of tissue plasminogen activator, hemorrhage displacement with liquid perfluorocarbon, gas tamponade, and face-down positioning. Saudi J Ophthalmol 2018; 32:269-274. [PMID: 30581295 PMCID: PMC6300785 DOI: 10.1016/j.sjopt.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/29/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the outcomes of vitrectomy, subretinal tissue plasminogen activator (tPA) injection, hemorrhage displacement with liquid perfluorocarbon, gas tamponade, and face-down positioning, in hemorrhagic neovascular age-related macular degeneration (AMD) patients. Methods In this retrospective case series, we reviewed the records of patients who were diagnosed as having submacular hemorrhage (SMH) secondary to neovascular AMD between January and June 2016. The main outcome measure was the difference between preoperative and postoperative best corrected visual acuity (BCVA). Results In 9 eyes of 9 patients, mean preoperative and postoperative BCVA at the last follow-up were 1.65 and 1.49 LogMAR, respectively (p = 0.1), after a mean follow up time of 12.4 ± 1.0 months. The SMH was successfully displaced in 5 of the 9 patients (55.5%). Four out of 9 patients (44.4%) gained ≥3 lines. The duration of SMH was 3.6 ± 2.1 days (range 1-7) in the successfully displacement group, and was 10.0 ± 1.8 days (range 8-12) in the group in which was SMH could not be displaced (p = 0.002). The mean SMH area was smaller in the successfully displacement group than the group in which was SMH could not be displaced (p = 0.04). Conclusion Vitrectomy, subretinal tPA injection, hemorrhage displacement with liquid perfluorocarbon, gas tamponade and face-down positioning was associated with improved visual outcomes in patients with hemorrhagic neovascular AMD. The duration and area of the SMH seemed to be related to the success of displacement.
Collapse
Affiliation(s)
- Abdullah Ozkaya
- Corresponding author at: Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey.
| | | | | |
Collapse
|