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.