Vitrectomy with subretinal tissue plasminogen activator (r-TPA) and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for submacular hemorrhages treatment: Retrospective analysis of 22 cases.

BACKGROUND: Macular hemorrhages are a severe complication of other retinal pathologies, such as age-related macular degeneration (AMD) or macroaneurysms. Their therapeutic approach is not standardized, and can vary from observation to surgical treatment. MATERIAL AND METHODS: Retrospective analysis of 22 cases of macular hemorrhage, treated with vitrectomy associated to subretinal rTPA and intravitreal anti-VEGF over a period of 5 years. RESULTS: 22 eyes of 22 patients were included, of which 12 (52%) were women. The mean age at diagnosis was 84.4 years. 13 patients were pseudophakic (54.1%) and 19 (86.36%) had previous ophthalmological comorbidities. The etiology of the macular hemorrhage was AMD in 19 patients (86.36%). The mean of best VA corrected at diagnosis was 24.55 (Early Treatment Diabetic Retinopathy Study score -ETDRS), with a statistically significant improvement to 36.78 3 months after surgery (p = 0.011). With an average of 23.5 months of follow-up, no differences in prognosis associated with the etiology or size of the hemorrhage were observed. CONCLUSION: The treatment of macular hemorrhages by vitrectomy, subretinal rTPA and antiVEGF improves the visual prognosis of affected patients.

Vitrectomía asociada a activador tisular del plasminógeno (rTPA) subretiniano e inyección intravítrea de anti-VEGF como tratamiento de hemorragias submaculares: análisis retrospectivo de 22 casos / Vitrectomy with subretinal tissue plasminogen activator (r-TPA) and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for submacular hemorrhages treatment: Retrospective analysis of 22 cases

Introducción: Las hemorragias maculares suponen una complicación severa de otras patologías retinianas, como la degeneración macular asociada a la edad (DMAE) o los macroaneurismas. El abordaje terapéutico de las mismas no se encuentra estandarizado, pudiendo variar desde la observación hasta el tratamiento quirúrgico.Material y métodosAnálisis retrospectivo de 22 casos de hemorragia macular, tratados mediante vitrectomías asociada a rTPA subretiniano y antiVEGF intravítreo durante un período de cinco años.ResultadosSe incluyeron 22 ojos de 22 pacientes, de los que 12 (52%) eran mujeres. La edad media al diagnóstico fue de 84,4 años. Del total de pacientes, 13 eran pseudofáquicos (54,1%) y 19 (86,36%) presentaban comorbilidades oftalmológicas previas. La etiología de las hemorragias maculares fue DMAE en 19 pacientes (86,36%). La media de mejor agudeza visual (AV) corregida al diagnóstico fue de 24,55 (puntuación Early Treatment Diabetic Retinopathy Study - ETDRS), con una mejoría estadísticamente significativa a 36,78 a los tres meses de la cirugía (p=0,011). Con un promedio de 23,5 meses de seguimiento, no se observaron diferencias en el pronóstico asociadas a etiología o tamaño de la hemorragia.ConclusiónEl tratamiento de las hemorragias maculares mediante vitrectomía, rTPA subretiniano y antiVEGF mejora el pronóstico visual de los pacientes afectos. (AU)

Background: Macular hemorrhages are a severe complication of other retinal pathologies, such as age-related macular degeneration (AMD) or macroaneurysms. Their therapeutic approach is not standardized, and can vary from observation to surgical treatment.Material and methodsRetrospective analysis of 22 cases of macular hemorrhage, treated with vitrectomy associated to subretinal rTPA and intravitreal anti-VEGF over a period of 5 years.Results22 eyes of 22 patients were included, of which 12 (52%) were women. The mean age at diagnosis was 84.4 years. 13 patients were pseudophakic (54.1%) and 19 (86.36%) had previous ophthalmological comorbidities. The etiology of the macular hemorrhage was AMD in 19 patients (86.36%). The mean of best VA corrected at diagnosis was 24.55 (Early Treatment Diabetic Retinopathy Study score -ETDRS), with a statistically significant improvement to 36.78 3 months after surgery (p = 0.011). With an average of 23.5 months of follow-up, no differences in prognosis associated with the etiology or size of the hemorrhage were observed.ConclusionThe treatment of macular hemorrhages by vitrectomy, subretinal rTPA and antiVEGF improves the visual prognosis of affected patients. (AU)

[Treatment of retinal re-detachment in eyes with intraocular silicone oil]. / Tratamiento del redesprendimiento de la retina en ojos con aceite de silicona intraocular.

PURPOSE: To describe the standardized surgical technique we used to treat recurrent retinal detachment in eyes that had been previously operated on with silicone oil. METHOD: We present 6 cases in which the following surgical steps were carried out as a standardized procedure: 1) silicone oil extraction, 2) partial introduction of perfluorcarbon liquids (PFCL), 3) extraction of epiretinal membranes, 4) endodiathermy, 5) retinotomy, 6) retinectomy, 7) complete filling of the intraocular cavity with PFCL, 8) endophotocoagulation and 9) 5,000 Cs silicone oil injection. RESULTS: All the patients maintained the reattached retina. Five of them still have the silicone oil in the vitreous cavity. One patient suffered a macular epiretinal membrane. A second patient presented a macular epiretinal membrane with subfoveal PFCL as well as a relapse of the retinal re-detachment when we extracted the silicone oil during the macular surgery, so that it had to be re-introduced. All of the patients, except two who were aphakic, developed different degrees of cataracts. CONCLUSIONS: The systematic use of these surgical steps can be very useful in the management of retinal detachment relapses in eyes previously treated with silicone oil injection.

Tratamiento del redesprendimiento de la retina en ojos con aceite de silicona intraocular / Treatment of retinal re-detachment in eyes with intaocular silicone oil

Objetivo: Describir la técnica quirúrgica que realizamos de un modo protocolizado para tratar la recidiva del desprendimiento de la retina en ojos que ya han sido operados previamente con aceite de silicona. Método: Presentamos 6 casos donde realizamos de un modo estandarizado los siguientes pasos quirúrgicos: 1.º extracción del aceite de silicona, 2.º introducción parcial de líquidos perfluorocarbonados (PFCL), 3.º extracción de las membranas epirretinianas, 4.º endodiatermia, 5.º retinotomía, 6.º retinectomía, 7.º relleno completo de la cavidad vítrea con PFCL, 8.º endofotocoagulación y 9.º inyección de aceite de silicona de 5.000 Cs. Resultados: Todos los pacientes permanecen con la retina adaptada. Cinco de los cuales permanecen con la silicona intraocular. Un paciente padeció una membrana epirretiniana y otro presentó una membrana epirretiniana con PFCL subfoveal, el cual sufrió una recidiva del desprendimiento de la retina cuando extraíamos el aceite de silicona durante la cirugía macular por lo que tuvimos que introducirlo de nuevo. Todos los pacientes excepto dos de ellos, que eran afáquicos, desarrollaron cataratas en diferentes grados. Conclusiones: El uso sistematizado de estos pasos quirúrgicos puede ser de gran utilidad en el tratamiento de las recidivas del desprendimiento de la retina en ojos previamente tratados con aceite de silicona. (AU)