97th DOG Annual Meeting 1999



B. Wiechens, G. Häring

Background: In large subretinal hemorrhages associated with age-related macular degeneration (AMD) subretinal surgery is the treatment of choice. Small accompanying hemorrhages in choroidal neovascularization (CNV) usually show good spontaneous resorption. However, there is controversy on the therapeutic approach of those hemorrhages that are too large in size to resorb and too small to indicate subretinal extraction. In these patients we performed intravitreal r-TPA-/SF6-injection as first surgical intervention.

Material and methods: Twenty eyes of 20 patients were evaluated in this study. Mean age was 75.9 ± 7.1 years (range: 60-88 years). Average duration of symptoms prior to treatment was 15.5 days (range: 3-28 days). All patients received intravitreal injection of 50 µg r-TPA and 0.4 ml SF6 in local anesthesia. After displacement of the subretinal hemorrhage fluorescein angiography (FAG) was performed in all eyes to assess further treatment options. Follow-up was 4.1 ± 2.2 months (1-12 months).

Results: Preoperative visual acuity (V.A.) was between counting fingers and 20/60. After surgery, improvement of V.A. of more than 2 lines was observed in 7 out of 20 eyes. In 10 eyes V.A. was unchanged, the remaining 3 eyes showed a decrease in V.A. FAG revealed classic, extrafoveal CNV in 1 eye. In this patient near vision increased to Nieden 1 after lasercoagulation. In 3 eyes subfoveal CNVs were surgically extracted. In these cases only stabilization of V.A. was achieved. FAG in the remaining eyes exhibited occult CNVs that were not treated. No postoperative complications were observed.

Conclusions: By means of combined intravitreal r-TPA-/SF6-injection improvement of V.A. can be achieved in some cases. Gain of V.A., however, depends on the natural course of the disease. After displacement of the subretinal hemorrhage further diagnostic of therapeutic options can be expedited and facilitated. This treatment modality is rare of complications and should be considered under above conditions.

Section of Vitreoretinal Surgery Dept of Ophthalmology, Christian-Albrechts-University Kiel, Hegewischstr. 2, D - 24105 Kiel