Authors
Bosov E.D., Kalinin M.E., Karpov G.O., Bogdanova V.A.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Backgraund: Age-related macular degeneration is a disease that threatens the complete loss of vision in the elderly. The development of choroidal neovascularization in some cases leads to the release of blood into the submacular space. In the long term, patients with submacular hemorrhages have irreversible vision loss due to degenerative-atrophic changes in the outer layers of the retina.
Aims: to determine changes in the morphological and functional parameters of the retina in patients with submacular hemorrhage against the background of age-related macular degeneration, depending on the duration of changes in the anatomical parameters of the pigment sheet.
Materials and methods: Depending on the choice of surgical treatment, patients were divided into two groups depending on the duration of the course of age-related macular degeneration: Group 1 (24 patients/24 eyes) — submacular hemorrhages with newly diagnosed age-related macular degeneration; group 2 (19 patients/19 eyes) — submacular hemorrhages with an established diagnosis of age-related macular degeneration for more than 12 months. In both groups, combined treatment was performed, including subretinal administration of a solution of recombinant prourokinase and tamponade with hexafluoroethane, followed by antivasoproliferative therapy.
Results: After vitreoretinal intervention, a decrease in the central retinal thickness in the 1st and 2nd groups was demonstrated by 61% and 53% of the initial values, and the size of the detachment of the retinal pigment epithelium — by 70% and 60%, respectively. Against the background of the ongoing treatment tactics, in all cases, it was possible to achieve dislocation of submacular hemorrhage in 89% of cases and significantly level the hemorrhagic detachment of the pigment sheet, regardless of the area and volume of hemorrhage. In the period up to 1 year in both groups, an increase in visual acuity was demonstrated, however, at the end of the 12-month follow-up, stabilization of visual functions was observed in group 1, and a significant decrease in visual functions to 0.1±0.04 was observed in group 2.
Conclusions: Combined treatment of patients with submacular hemorrhages associated with age-related macular degeneration, including subretinal administration of tissue plasminogen activator against the background of antivasoproliferative therapy, improves the morphofunctional results of the retina. However, long-term prospects depend on the state of the retinal pigment epithelium and the duration of the course of age-related macular degeneration.
Keywords: submacular hemorrhage; tissue plasminogen activator; retinal pigment epithelium; age-related macular degeneration.
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