Article
Treatment of wet-age related macular degeneration (AMD) with rt-PA and anti-VEGF
Search Medline for
Authors
Published: | September 21, 2010 |
---|
Outline
Text
Background: At present the treatment of exudative age-related macular degeneration (AMD) with Anti-VEGF injections is not sufficient in all cases. Those eyes that do not respond to anti-VEGF therapy present vitreous adhesion to the retina or even vitreoretinal traction at the macula.Vitreous liquefaction could support the treatment of anti-VEGF-injections.
Patients and methods: For liquefying the vitreous we combined the injection of anti-VEGF with plasminogenaktivator. In 12 patients with wet AMD and adherent posterior vitreous we once injected 60μg rt-PA, 1.25 mg Bevacizumab and 0.3 ml of SF6 gas in the vitreous cavity under local anaesthesia. Five of the eyes were previously treated unsuccessfully with anti-VEGF. Monitoring by FAG and OCT during the follow up period.
Results: In 10 out of 12 eyes we found no macular traction by OCT four weeks after injection. At the 8 month follow-up 7 eyes. improved by a single treatment and showed an inactive CNV. Four patients need two additional anti-VEGF injections. One patient required a mac-rotation due to a starting of subretinal fibrosis.
Discussion: The vitreolyse by rt-PA can caused a PVD, reduction of vitreous traction, a better oxygenation of the retina and therfore a reduction of VEGF expression. This could improve the efficacy of anti-VEGF treatment in wet AMD. Whether rt-PA interacts directly with the CNV have to be shown in further investigations.