Retinal sensitivity after displacement of submacular hemorrhage due to polypoidal choroidal vasculopathy: effectiveness and safety of subretinal tissue plasminogen activator

Jpn J Ophthalmol. 2017 Nov;61(6):472-478. doi: 10.1007/s10384-017-0530-0. Epub 2017 Aug 23.

Abstract

Purpose: To investigate the effectiveness of displacement of submacular hemorrhage (SMH) caused by polypoidal choroidal vasculopathy (PCV) by assessing retinal sensitivity using microperimetry.

Methods: We retrospectively reviewed the medical records of 11 consecutive PCV patients with SMH. All patients underwent vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-air exchange, followed by antivascular endothelial growth factor therapy using a pro re nata regimen. The retinal sensitivity was measured by use of microperimetry before and after surgery.

Results: The mean (SD) age of the patients was 74.1 ± 9.4 years. The mean SMH diameter was 6.8 ± 5.2 disc diameters. The best-corrected visual acuity (BCVA), mean retinal sensitivity, and mean number of measure points with a sensitivity ≥10 dB before the surgery were 0.94 ± 0.49, 4.2 ± 4.5 dB, and 15.6 ± 15.1 points, respectively. These had significantly improved 6 months after surgery (0.39 ± 0.37, 15.6 ± 7.3 dB, and 50.9 ± 22.2 points, respectively; P < 0.05 for all outcome measures). The mean number of measure points with an absolute scotoma before surgery had decreased significantly 6 months after surgery (from 40.5 ± 15.0 to 9.4 ± 16.0 points; P < 0.001).

Conclusions: Displacement of SMH effectively improves retinal sensitivity as well as BCVA.

Keywords: Microperimetry; Polypoidal choroidal vasculopathy; Submacular hemorrhage; Tissue plasminogen activator.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Choroid / blood supply*
  • Choroid Diseases / complications*
  • Choroid Diseases / diagnosis
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fluorescein Angiography
  • Follow-Up Studies
  • Fundus Oculi
  • Humans
  • Injections
  • Macula Lutea / blood supply*
  • Male
  • Middle Aged
  • Retina
  • Retinal Hemorrhage / diagnosis
  • Retinal Hemorrhage / drug therapy*
  • Retinal Hemorrhage / etiology
  • Retrospective Studies
  • Tissue Plasminogen Activator / administration & dosage*
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Visual Acuity
  • Visual Field Tests

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator