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

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.

[Management of Radius-Maumenee syndrome : Treatment with deep sclerectomy, viscocanalostomy and collagen matrix implantation]. / Management des Radius-Maumenee-Syndroms : Therapie mit tiefer Sklerektomie, Viskokanalostomie und Kollagenmatriximplantation.

We describe the case of an 18-year-old female patient who presented with vasodilation of the episcleral vessels in both eyes. The dilated vessels were more prominent in the right eye and, furthermore, examination of the fundus oculi showed a glaucomatous excavation of the right optic disc. No underlying eye or systemic disease was found as the cause for the vasodilation, therefore, Radius-Maumenee syndrome (idiopathic dilated episcleral vessels with secondary open angle glaucoma) was diagnosed. Radius-Maumenee syndrome is a diagnosis by exclusion. If no underlying disease can be detected primary therapy of the glaucoma is required. Carotid cavernous fistulas as the most common cause for dilated episcleral vessels and elevated episcleral venous pressure should be ruled out. Due to the progression of the excavation and the pathologically elevated intraocular pressure in the right eye of our patient we decided to perform a deep sclerectomy in combination with viscocanalostomy and implantation of a collagen matrix. The operation and postoperative period were free from complications. Two months after the surgical procedure the right eye showed a normalized intraocular pressure of 7 mmHg but no morphological changes in terms of reduction of the vasodilation. In summary, deep sclerectomy in combination with viscocanalostomy and implantation of a collagen matrix showed good results in the reduction of intraocular eye pressure in Radius-Maumenee syndrome.