Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Japanese Journal of Ophthalmology
Published in: Japanese Journal of Ophthalmology 6/2017

01-11-2017 | Clinical Investigation

Retinal sensitivity after displacement of submacular hemorrhage due to polypoidal choroidal vasculopathy: effectiveness and safety of subretinal tissue plasminogen activator

Authors: Shuhei Kimura, Yuki Morizane, Ryo Matoba, Mio Hosokawa, Yusuke Shiode, Masayuki Hirano, Shinichiro Doi, Shinji Toshima, Kosuke Takahashi, Mika Hosogi, Atsushi Fujiwara, Fumio Shiraga

Published in: Japanese Journal of Ophthalmology | Issue 6/2017

Login to get access

Abstract

Purpose

To investigate the effectiveness of displacement of submacular hemorrhage (SMH) caused by polypoidal choroidal vasculopathy (PCV) by assessing retinal sensitivity using microperimetry.

Methods

We retrospectively reviewed the medical records of 11 consecutive PCV patients with SMH. All patients underwent vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-air exchange, followed by antivascular endothelial growth factor therapy using a pro re nata regimen. The retinal sensitivity was measured by use of microperimetry before and after surgery.

Results

The mean (SD) age of the patients was 74.1 ± 9.4 years. The mean SMH diameter was 6.8 ± 5.2 disc diameters. The best-corrected visual acuity (BCVA), mean retinal sensitivity, and mean number of measure points with a sensitivity ≥10 dB before the surgery were 0.94 ± 0.49, 4.2 ± 4.5 dB, and 15.6 ± 15.1 points, respectively. These had significantly improved 6 months after surgery (0.39 ± 0.37, 15.6 ± 7.3 dB, and 50.9 ± 22.2 points, respectively; P < 0.05 for all outcome measures). The mean number of measure points with an absolute scotoma before surgery had decreased significantly 6 months after surgery (from 40.5 ± 15.0 to 9.4 ± 16.0 points; P < 0.001).

Conclusions

Displacement of SMH effectively improves retinal sensitivity as well as BCVA.
Literature
1.
Uyama M, Wada M, Nagai Y, Matsubara T, Matsunaga H, Fukushima I, et al. Polypoidal choroidal vasculopathy: natural history. Am J Ophthalmol. 2002;133:639–48.CrossRefPubMed
2.
Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T, et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003;121:1392–6.CrossRefPubMed
3.
Cho JH, Ryoo N-K, Cho KH, Park SJ, Park KH, Woo SJ. Incidence rate of massive submacular hemorrhage and its risk factors in polypoidal choroidal vasculopathy. Am J Ophthalmol. 2016;169:79–88.CrossRefPubMed
4.
Ohji M, Saito Y, Hayashi A, Lewis JM, Tano Y. Pneumatic displacement of subretinal hemorrhage without tissue plasminogen activator. Arch Ophthalmol. 1998;116:1326–32.CrossRefPubMed
5.
Hesse L, Schmidt J, Kroll P. Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas. Graefes Arch Clin Exp Ophthalmol. 1999;237:273–7.CrossRefPubMed
6.
Haupert CL, McCuen BW, Jaffe GJ, Steuer ER, Cox TA, Toth CA, et al. Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration. Am J Ophthalmol. 2001;131:208–15.CrossRefPubMed
7.
Fine HF, Iranmanesh R, Del Priore LV, Barile GR, Chang LK, Chang S, et al. Surgical outcomes after massive subretinal hemorrhage secondary to age-related macular degeneration. Retina. 2010;30:1588–94.CrossRefPubMed
8.
Kimura S, Morizane Y, Hosokawa M, Shiode Y, Kawata T, Doi S, et al. Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator. Am J Ophthalmol. 2015;159:683–9.CrossRefPubMed
9.
van Zeeburg EJT, van Meurs JC. Literature review of recombinant tissue plasminogen activator used for recent-onset submacular hemorrhage displacement in age-related macular degeneration. Ophthalmologica. 2013;229:1–14.CrossRefPubMed
10.
Steel DHW, Sandhu SS. Submacular haemorrhages associated with neovascular age-related macular degeneration. Br J Ophthalmol. 2011;95:1051–7.CrossRefPubMed
11.
Toth CA, Morse LS, Hjelmeland LM, Landers MB. Fibrin directs early retinal damage after experimental subretinal hemorrhage. Arch Ophthalmol. 1991;109:723–9.CrossRefPubMed
12.
Benner JD, Morse LS, Toth CA, Landers MB, Hjelmeland LM. Evaluation of a commercial recombinant tissue-type plasminogen activator preparation in the subretinal space of the cat. Arch Ophthalmol. 1991;109:1731–6.CrossRefPubMed
13.
Hillenkamp J, Surguch V, Framme C, Gabel V-P, Sachs HG. Management of submacular hemorrhage with intravitreal versus subretinal injection of recombinant tissue plasminogen activator. Graefes Arch Clin Exp Ophthalmol. 2010;248:5–11.CrossRefPubMed
14.
Vujosevic S, Midena E, Pilotto E, Radin PP, Chiesa L, Cavarzeran F. Diabetic macular edema: correlation between microperimetry and optical coherence tomography findings. Invest Ophthalmol Vis Sci. 2006;47:3044–51.CrossRefPubMed
15.
Pranger F, Michels S, Geitzenauer W, Schmidt-Erfurth U, Simader C. Changes in retinal sensitivity in patients with neovascular age-related macular degeneration after systemic bevacizumab (Avastin) therapy. Retina. 2008;28:682–8.CrossRef
16.
Parravano M, Oddone F, Tedeschi M, Chiaravalloti A, Perillo L, Boccassini B, et al. Retinal functional changes measured by microperimetry in neovascular age-related macular degeneration treated with ranibizumab. Retina. 2010;30:1017–24.CrossRefPubMed
17.
Ozdemir H, Karacorlu M, Senturk F, Karacorlu SA, Uysal O. Microperimetric changes after intravitreal bevacizumab injection for exudative age-related macular degeneration. Acta Ophthalmol. 2010;90:71–5.CrossRefPubMed
18.
Crossland M, Jackson M-L, Seiple WH. Microperimetry: a review of fundus related perimetry. Optom Rep. 2012;2:11–5.
19.
Cho HJ, Kim CG, Yoo SJ, Cho SW, Lee DW, Kim JW, et al. Retinal functional changes measured by microperimetry in neovascular age-related macular degeneration treated with ranibizumab. Am J Ophthalmol. 2013;155:118–26.CrossRefPubMed
20.
Imamura Y, Engelbert M, Iida T, Freund KB, Yannuzzi LA. Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol. 2010;55:501–15.CrossRefPubMed
21.
Treatment of Age-Related Macular Degeneration With Photodynamic Therapy. (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials–TAP report. Arch Ophthalmol. 1999;117:1329–45.CrossRef
22.
Sato S, Hirooka K, Baba T, Tenkumo K, Nitta E, Shiraga F. Correlation between the ganglion cell inner plexiform layer thickness measured with Cirrus HD-OCT and macular visual field sensitivity measured with microperimetry. Invest Ophthalmol Vis Sci. 2012;54:3046–51.CrossRef
23.
Wu Z, Jung CJ, Ayton LN, Luu CD, Guymer RH. Test–retest repeatability of microperimetry at the border of deep scotomas. Invest Ophthalmol Vis Sci. 2015;56:2606–11.CrossRefPubMed
24.
Koh A, Lee WK, Chen L-J, Chen S-J, Hashad Y, Kim H, et al. EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina. 2012;32:1453–64.CrossRefPubMed
25.
Scupola A, Coscas G, Soubrane G, Balestrazzi E. Natural history of macular subretinal hemorrhage in age-related macular degeneration. Ophthalmologica. 1999;213:97–102.CrossRefPubMed
26.
Okanouchi T, Toshima S, Kimura S, Morizane Y, Shiraga F. Novel technique for subretinal injection using local removal of the internal limiting membrane. Retina. 2016;36:1035–8.CrossRefPubMed
27.
Treumer F, Roider J, Hillenkamp J. Long-term outcome of subretinal coapplication of rtPA and bevacizumab followed by repeated intravitreal anti-VEGF injections for neovascular AMD with submacular haemorrhage. Br J Ophthalmol. 2012;96:708–13.CrossRefPubMed
28.
Kim JH, Kim JW, Lee TG, Lew YJ. Treatment outcomes in eyes with polypoidal choroidal vasculopathy with poor baseline visual acuity. J Ocul Pharmacol Ther. 2015;31:241–7.CrossRefPubMed
29.
Chang YS, Kim JH, Kim JW, Lee TG, Kim CG, Cho SW. Polypoidal choroidal vasculopathy in patients aged less than 50 years: characteristics and 6-month treatment outcome. Graefes Arch Clin Exp Ophthalmol. 2016;254:1–7.CrossRef
30.
Lin T-C, Hwang D-K, Lee F-L, Chen S-J. Visual prognosis of massive submacular hemorrhage in polypoidal choroidal vasculopathy with or without combination treatment. J Chin Med Assoc. 2016;79:159–65.CrossRefPubMed
31.
Lee SS, Ghosn C, Yu Z, Zacharias LC, Kao H, Lanni C, et al. Vitreous VEGF clearance is increased after vitrectomy. Invest Ophthalmol Vis Sci. 2010;51:2135–8.CrossRefPubMed
32.
Kakinoki M, Sawada O, Sawada T, Saishin Y, Kawamura H, Ohji M. Effect of vitrectomy on aqueous VEGF concentration and pharmacokinetics of bevacizumab in macaque monkeys. Invest Ophthalmol Vis Sci. 2012;53:5877–80.CrossRefPubMed
33.
Christoforidis JB, Williams MM, Wang J, Jiang A, Pratt C, Abdel-Rasoul M, et al. Anatomic and pharmacokinetic properties of intravitreal bevacizumab and ranibizumab after vitrectomy and lensectomy. Retina. 2013;33:946–52.CrossRefPubMedPubMedCentral
34.
Mizutani T, Yasukawa T, Ito Y, Takase A, Hirano Y, Yoshida M, et al. Pneumatic displacement of submacular hemorrhage with or without tissue plasminogen activator. Graefes Arch Clin Exp Ophthalmol. 2011;249:1153–7.CrossRefPubMed
35.
Saito M, Kano M, Itagaki K, Oguchi Y, Sekiryu T. Retinal pigment epithelium tear after intravitreal aflibercept injection. Clin Ophthalmol. 2013;7:1287–9.CrossRefPubMedPubMedCentral
36.
Ersoz MG, Karacorlu M, Arf S, Sayman Muslubas I, Hocaoglu M. Retinal pigment epithelium tears: classification, pathogenesis, predictors, and management. Surv Ophthalmol. 2017;62:493–505.CrossRefPubMed
Metadata
Title
Retinal sensitivity after displacement of submacular hemorrhage due to polypoidal choroidal vasculopathy: effectiveness and safety of subretinal tissue plasminogen activator
Authors
Shuhei Kimura
Yuki Morizane
Ryo Matoba
Mio Hosokawa
Yusuke Shiode
Masayuki Hirano
Shinichiro Doi
Shinji Toshima
Kosuke Takahashi
Mika Hosogi
Atsushi Fujiwara
Fumio Shiraga
Publication date
01-11-2017
Publisher
Springer Japan
Published in
Japanese Journal of Ophthalmology / Issue 6/2017
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-017-0530-0

Other articles of this Issue 6/2017

Japanese Journal of Ophthalmology 6/2017 Go to the issue

Clinical Investigation

Effectiveness and safety of combined cataract surgery and microhook ab interno trabeculotomy in Japanese eyes with glaucoma: report of an initial case series

Clinical Investigation

Changes in the size of the foveal avascular zone after vitrectomy with internal limiting membrane peeling for a macular hole

Clinical Investigation

Measurement repeatability of the dynamic Scheimpflug analyzer

Clinical Investigation

Decreased ocular blood flow after photocoagulation therapy in neonatal retinopathy of prematurity

Clinical Investigation

Evaluating internal and ocular residual astigmatism in Chinese myopic children

Clinical Investigation

Assessment of peripapillary choroidal thickness in primary open-angle glaucoma patients with choroidal vascular prominence