gms | German Medical Science

23rd Annual Meeting of the German Retina Society

German Retina Society

24.09. - 25.09.2010, Freiburg

Treatment of wet-age related macular degeneration (AMD) with rt-PA and anti-VEGF

Meeting Abstract

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  • Jörg C. Schmidt - Eye Clinic Tausendfensterhaus Duisburg
  • C.B.G. Thimm - Eye Clinic Tausendfensterhaus Duisburg

German Retina Society. 23rd Annual Conference of the German Retina Society. Freiburg i. Br., 24.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10rg12

doi: 10.3205/10rg12, urn:nbn:de:0183-10rg126

This is the translated version of the article.
The original version can be found at:

Published: September 21, 2010

© 2010 Schmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.