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Post vitreous injection course of t-PA, gas, and anti-VEGF drugs for submacular hemorrhage due to age-related macular degeneration Yasuhito Ikegawa 1 , Tomohiko Torikai 1 , Yukako Hiramatsu 1 , Takeshi Kobayashi 1 , Atsushi Shiraishi 1 1Department of Ophthalmology, Ehime University School of Medicine pp.1343-1350
Published Date 2023/10/15
DOI https://doi.org/10.11477/mf.1410214943
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Abstract Purpose:Submacular hemorrhage due to age-related macular degeneration(AMD)is considered to have a poor prognosis, and early removal of the blood is important for improving visual acuity. Ranibizumab, monteplase, and C3F8 were injected into the vitreous humor alone for hematoma migration in submacular hemorrhage, and the results of treatment were investigated.

Subject and Method:The participants were 9 patients with submacular hemorrhage due to AMD who visited Ehime University Hospital from April 2021 to March 2022:9 eyes(7 males, 2 females, average age 76.4±10.7 years old). After vitreal injection of ranibizumab, monteplase, and C3F8, the patients were placed in prone position for 48 hours and observed for 6 months.

Results:The average number of days from onset to treatment was 17.9±26.2 days. Pretreatment log MAR visual acuity was 1.2±0.5, foveal retinal thickness was 687±306 μm, and foveal PED thickness was 337±305 μm.

Six months after treatment, log MAR visual acuity was 1.1±0.6(p=1.0), foveal retinal thickness was 219±159 μm(p=0.04), and foveal PED thickness was 216±313 μm(p=0.6). Submacular hemorrhage showed downward movement in all cases. Complications included vitreous hemorrhage in 2 cases. As additional treatment, vitrectomy was performed in 2 patients with vitreous hemorrhage, and anti-VEGF administration was performed in 5 patients with exudative changes.

Conclusions:In this study, the patient was restricted to the prone position after injection, and the submacular hemorrhage moved downward in all cases. It is necessary to further investigate whether the movement direction and amount of bleeding are affected by posture. There have been few reports of hematoma migration due to monteplase, and further investigation of the dosage is necessary. Even after submacular hematoma migration, rebleeding and exudative changes that affect visual acuity may occur, and further investigation is required regarding the method of hematoma migration.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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