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Combined Intravitreal Utilization of rTPA and SF6 in Age-related Macular Degeneration in a Long-time Follow-up

1Beutelspacher S. C., 2Wirt H., 2von Domarus D.,
1Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik, Interdisziplinäres Uveitis-Zentrum (Heidelberg)
2Allgemeines Krankenhaus Barmbek, Augenklinik (Hamburg)

Purpose: Subretinale hemorrhage following age-related macular degeneration has commonly a bad prognosis for the further development of visual acuity. Surgical drainage only rarely leads to an improvement. The aim of this study was to evaluate the effect of the combined utilization of rTPA, SF6-Gas and posterior vitrectomy.
Method: 33 Patients of the department of ophthalmology of the General Hospital Barmbek with acute subretinal hemorrhage following AMD with detachment of neurosensoric retina were included. The combined utilization was performed 1-5 days after bleeding. In local anaesthesia 50µg rTPA in 0,1 ml BSS and 2ml SF6 Gas were injected via pars plana after local posterior vitrectomy. The patients were positioned strictly on back for 24 hours. The detection of visual acuity was performed 7 days after operation.
Results: The injection of rTPA led to a partial or complete liquification of the coagulated hemorrhage. A directly postoperative increasing of visual acuity was detected in 22 cases. 4 cases showed stabilization and 7 cases showed a reduction of visual acuity. The detection of visual acuity after 6 months showed an improvement in 28 cases and only a reduction in 5 cases.
Conclusions: The combined utilization of rTPA and SF6 is a method easily to perform in treatment of acute submacular hemorrhage to provide the patients an improvement of visual acuity and quality of life. The removal of hemorrhage is reached by the combination of the two drugs.