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Klin Monbl Augenheilkd 2017; 234(04): 487-492
DOI: 10.1055/s-0042-121575
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Efficacy of Vitrectomy Combined with Subretinal rtPA Injection with Gas or Air Tamponade

Vitrektomie mit subretinaler rtPA-Injektion kombiniert mit Gas- oder Luftendotamponade
M. Waizel
1   University Eye Clinic Basel, Centre for Ophthalmology, Basel, Switzerland
2   Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar
,
M. G. Todorova
1   University Eye Clinic Basel, Centre for Ophthalmology, Basel, Switzerland
,
A. Rickmann
2   Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar
,
B. R. Blanke
3   University Eye Clinic Tuebingen, Centre for Ophthalmology, Tuebingen
,
P. Szurman
2   Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar
3   University Eye Clinic Tuebingen, Centre for Ophthalmology, Tuebingen
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Publikationsdatum:
31. Januar 2017 (online)

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Abstract

Background Functional and anatomical outcome after vitrectomy with rtPA combined with gas or air tamponade.

Patients and methods Retrospective analysis of pseudophakic patients treated with subretinal rtPA and gas or air tamponade. The primary endpoint was displacement of haemorrhage six months after surgery. The secondary endpoints were visual acuity (BCVA), haemorrhage diameter (MHD) and central macular thickness (CMT), as measured by SD-OCT.

Results 53 of 85 eyes were pseudophakic. 27 of these eyes were treated with air tamponade and 26 with gas tamponade. For patients with air tamponade, the mean BCVA improved from 20/530 to 20/355 (p = 0.01). MHD and CMT decreased from 6386 ± 2281 µm to 3805 ± 2397 µm (p < 0.001) and 895 ± 592 µm to 532 ± 386 µm (p < 0.001), respectively. For patients with gas tamponade, the mean BCVA improved only slightly, from 20/471 to 20/394 (p = 0.17). MHD and CMT exhibited statistically significant decreases from 6759 ± 1773 µm to 3525 ± 1548 µm (p < 0.001) and 1089 ± 587 µm to 537 ± 251 µm (p < 0.001), respectively.

Conclusions Vitrectomy with subretinal rtPA injection has strong functional and anatomical effects on submacular haemorrhages with both gas and air tamponade.

Zusammenfassung

Hintergrund Ziel der Studie war es die funktionellen und anatomischen Ergebnisse nach einer Vitrektomie mit subretinaler Recombinant-tissue-plasminogen-(rtPA-)Injektion kombiniert mit Gas- gegen Luftendotamponade zu vergleichen.

Patienten und Methoden Retrospektive Analyse von Patienten mit subretinaler Massenblutung, die mit Vitrektomie, subretinaler rtPA-Injektion und Gas- oder Luftendotamponade behandelt wurden. Primärer Endpunkt war die Verdrängung der Blutung 6 Monate nach der Behandlung. Sekundäre Endpunkte waren der bestkorrigierte Visus (BCVA), maximaler Durchmesser der Blutung (MHD) und die zentrale Makulaschichtdicke (CMT), jeweils gemessen mit optischer Kohärenztomografie.

Ergebnisse Von 85 Augen waren 53 pseudophak. Davon wurden 27 mit Luft- und 26 mit Gasendotamponade behandelt. Mit Luft behandelte Augen verbesserten sich signifikant von 20/530 auf 20/355 Snellen Visus (p = 0.01). MHD und CMT sanken signifikant von 6386 ± 2281 µm auf 3805 ± 2397 µm (p < 0.001) bzw. von 895 ± 592 µm auf 532 ± 386 µm (p < 0.001). Der Visus der mit Gas behandelten Augen verbesserte sich hingegen nur geringfügig von 20/471 auf 20/394 (p = 0.17). MHD und CMT sanken aber statistisch signifikant von 6759 ± 1773 µm auf 3525 ± 1548 µm (p < 0.001) bzw. von 1089 ± 587 µm auf 537 ± 251 µm (p < 0.001).

Schlussfolgerungen Vitrektomie mit subretinaler rtPA-Injektion hat einen starken funktionellen und anatomischen Effekt auf submakuläre Blutungen sowohl mit Gas- als auch Luftendotamponade.

Key words

subretinal haemorrhage - subretinal rtPA - subretinal recombinant tissue plasminogen activator - gas tamponade - air tamponade

Schlüsselwörter

subretinale Blutung - subretinale rtPA-Behandlung - Gastamponade - Lufttamponade
 

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