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Naïve subretinal haemorrhage due to neovascular age-related macular degeneration. pneumatic displacement, subretinal air, and tissue plasminogen activator: subretinal vs intravitreal aflibercept-the native study

Eye volume 37, pages 1659–1664 (2023)Cite this article

Subjects

Abstract

Objective

We aimed to compare visual and anatomical outcome in subretinal aflibercept vs. intravitreal aflibercept in the context of Pars Plana Vitrectomy (PPV), pneumatic displacement with subretinal air and subretinal tPA in patients with naïve submacular haemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD).

Design

Retrospective interventional cohort study.

Participants

80 patients treated with subretinal aflibercept vs. intravitreal aflibercept in the context of PPV, subretinal air and subretinal tPA in patients with SMH secondary to naïve nAMD.

Methods

Records were reviewed. Best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) were recorded at baseline and 24 months after treatment.

Main outcome measures

BCVA, CST, and number of anti VEGF treatment over follow-up period.

Results

The average duration from onset of symptoms to surgery was 1.26 days (range 0–3 days). Based on review of OCT images, SMH was subretinal in all 80 patients (100%), and sub-RPE in 29 patients (36.3%). Forty-one patients (51.25%) were treated with subretinal aflibercept (“subretinal group”), and 39 patients (48.75%) were treated with intravitreal aflibercept injections (“intravitreal group”). The groups were well balanced for age and gender p = 0.6588, and p = 0.263, respectively). Both groups showed statistically significant improvement in BCVA and CST (for all groups: p < 0.001). The mean number of anti VEGF given during follow-up period was statistically significantly lower in the “subretinal group” (p < 0.0001).

Conclusion

This study shows better management of the CNV, with a statistically significant lower need for anti-VEGF injections when treated with subretinal aflibercept compared to intravitreal application.

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Fig. 1: Colour fundus and OCT over the follow-up of 24 months in a patient intreated with subretinal aflibercept during the surgery.
Fig. 2: Step by Step Surgery, including subretinal aflibercept injection.

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Acknowledgements

Javier Ignacio Melamud MD. Head of external Emergency room at the Medical intitute of investigation “ Alfredo Lanari “, University of Buenos Aires. General pactitiones and Legal medical specialst, Univesity of Buenos Aires, Argentina. Marina Koury MD. consultant in methodology, epidemiologic, and research from the teaching and investigation department at medical institute of investigation “Alfredo Lanari“, Univestity of Buenos Aires, Argentina.

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Authors and Affiliations

  1. Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina

    Matias Iglicki & Diego Jose Quispe

  2. Medical Investigation Institute “Alfredo Lanari“, University of Buenos Aires, Buenos Aires, Argentina

    Marina Khoury & Javier Ignacio Melamud

  3. Ophthalmologic Institute, Buenos Aires, Argentina

    Lucas Donato

  4. Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Adiel Barak, Dinah Zur & Anat Loewenstein

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Contributions

MI, DJQ, MK—Substantial contributions to the conception or design of the work; the acquisition, analysis, and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JIM, LD, AB, AL, DZ—Substantial contributions to the conception or design of the work and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Matias Iglicki.

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All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submit- ted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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As this was a retrospective study, participants’ informed consent was not needed, in compliance with the Institutional review board (IRB) approval. This study protocol was reviewed and approved by the local IRB. The research adhered to the tenets of the Declaration of Helsinki.

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Iglicki, M., Khoury, M., Melamud, J.I. et al. Naïve subretinal haemorrhage due to neovascular age-related macular degeneration. pneumatic displacement, subretinal air, and tissue plasminogen activator: subretinal vs intravitreal aflibercept-the native study. Eye 37, 1659–1664 (2023). https://doi.org/10.1038/s41433-022-02222-z

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