Vitrectomy with subretinal tissue plasminogen activator and intravitreal injection of bevacizumab in the treatment of submacular haemorrhage secondary to wet AMD – case series

Aim of the study
To evaluate the outcome of pars plana vitrectomy, subretinal injection of tissue plasminogen activator (tPA), and intraocular injection of anti-VEGF (vascular endothelial growth factor) bevacizumab (Avastin) injection in patients with submacular haemorrhage (SMH) secondary to wet age-related macular degeneration (AMD).

Material and methods
Retrospective chart review of 10 patients who underwent vitrectomy, subretinal tPA (concentration 12.5 μg/0.1 ml), anti-VEGF bevacizumab injection into the vitreous cavity and partial fluid-air exchange due to SMH in wet AMD.

Results
Ten patients (6 female and 4 male) with SMH secondary to wet AMD were enrolled in the study. All the patients were operated on by the same surgeon and the same procedure was followed. The surgery was performed between day 7 and day 42 (mean 19.6 days) after the onset of the haemorrhage. Preoperative visual acuity (VA) was low, between hand movement (HM) and counting fingers (CF). All the patients experienced VA improvement, ranging from 0.05 to 0.8, after surgery. The observation period was a minimum of 6 months. After the surgery patients were put on regular treatment of wet AMD with anti-VEGF.

Conclusions
Surgical intervention – vitrectomy, subretinal tPA injection, anti-VEGF injection into the vitreous cavity and partial fluid-air exchange – is an effective procedure to achieve visual acuity improvement in cases of SMH secondary to wet AMD, even if performed late. No severe complications of the surgery were noted.