gms | German Medical Science

Aim: To compare the efficacy of three surgical methods. Subretinal vs intravitreal injection of recombinant tissue plasminogen activator (rt PA) in combination with pars plana vitrectomy (PPV), intravitreal injection of bevacizumab and pneumatic displacement of intravitreal injection with gas (Hexafluorethan-C2F6) and of pneumatic displacement with gas (Hexafluorethan-C2F6) of macular bleeding with intravitreal injection of rt PA and bevacizumab without vitrectomy.

Methods: Our study included three groups of surgical treatment with 85 patients. In the first group where pars plana vitrectomy was not performed, patients where treated with intravitreal injection of C2F6 gas, 1.25 mg of bevacizumab and rtPA (20µg (0.1 ml). Group A included 32 patients In the second and third group (group B and C) patients underwent a standard three-port PPV (23G), intravitreal injection of 1.25 mg bevacizumab, pneumatic displacement with C2F6 gas and injection of rt PA. The difference between group B and C is that in group B patients received rt PA subretinally (20µg (0.1 ml). and in group C intravitreally (20µg (0.1 ml). Group B included 42 patients and group C included 11 patients.

Results: The submacular hemorrhage was displaced from the foveal area in all eyes. Volume reduction of subretinal blood at 4 weeks postoperatively was more pronounced in group A than group B. In group A, mean BCVA change was logMAR 0.8, and in group B logMAR 1.0, without statistically significant difference between the two groups.

Conclusion: PPV with pneumatic displacement, intravitreal injection of bevacizumab and rt PA injection (intravitreal and subretinal) is a useful treatment option. Both methods showed a complete displacement of bleeding. Subretinal injection of rt PA showed no advantage in terms of visual acuity improvement compared to intravitreal injection but led to a marked improvement of retinal volume compared to intravitreal injection.