To evaluate a recently developed technique using intraoperative optical coherence tomography (OCT) to measure subretinal tissue plasminogen activator (tPA) volumes in patients with submacular hemorrhage secondary to exudative age-related macular degeneration (AMD). Three patients (72 to 83 years old) had 25-gauge pars plana vitrectomy, subretinal tPA, and a partial gas fill. An investigational intraoperative OCT system with a modified widefield noncontact indirect viewing apparatus was used to image subretinal tPA blebs. Using the recently developed technique, the volume and surface area in the segmented region of interest were determined. In each case, the delivered tPA volume measured from the syringe differed from the intraoperative OCT-measured subretinal tPA volume: Patient 1, 130 µL from syringe, 118 µL based on intraoperative OCT, 9% difference; Patient 2, 140 µL, 50 µL, 64%; Patient 3, 110 µL, 122 µL, 11%. The total bleb surface area was 129 mm in Patient 1, 55 mm in Patient 2, and 106 mm in Patient 3. This was the first human study to implement and evaluate intraoperative OCT image-based methods to obtain volumetric bleb measurements in patients receiving subretinal tPA for exudative AMD. This proof-of-concept study showed that intraoperative OCT-obtained bleb volume differed from intraoperative recordings, which could be explained by tPA delivery into the vitreous, efflux through the retinotomy, or human error. Intraoperative OCT can provide visualization and quantification of subretinal tPA bleb volume and surface area, which has implications for improved safety, efficacy, and analysis of the effects of subretinal drug delivery.
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http://dx.doi.org/10.1177/24741264241253920 | DOI Listing |
Eur J Ophthalmol
November 2024
Department of Retina-Vitreous, Narayana Nethralaya, Benguluru, India.
Purpose: To study the outcomes of patients presenting with submacular hemorrhage (SMH) and bacillary layer detachment (BALAD) following intervention.
Methods: This retrospective study examined fundus photographs and optical coherence tomography (OCT) scans to identify treatment-naive SMH and BALAD cases. Two groups were formed: SMH cases with and without BALAD.
Sci Rep
October 2024
Department of Ophthalmology, College of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, 05030, Republic of Korea.
Graefes Arch Clin Exp Ophthalmol
October 2024
Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan.
Acute submacular hemorrhage (SMH) can be caused by various diseases including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), and retinal arterial microaneurysm (RAM). The natural course of submacular hemorrhage is generally poor. Animal studies have suggested that the removal of subretinal hemorrhage may effectively reduce retinal damage caused by hemorrhage in humans and removal of submacular hemorrhage have been performed with limited visual outcomes.
View Article and Find Full Text PDFJ Vitreoretin Dis
May 2024
Department of Ophthalmology, Duke University, Durham, NC, USA.
To evaluate a recently developed technique using intraoperative optical coherence tomography (OCT) to measure subretinal tissue plasminogen activator (tPA) volumes in patients with submacular hemorrhage secondary to exudative age-related macular degeneration (AMD). Three patients (72 to 83 years old) had 25-gauge pars plana vitrectomy, subretinal tPA, and a partial gas fill. An investigational intraoperative OCT system with a modified widefield noncontact indirect viewing apparatus was used to image subretinal tPA blebs.
View Article and Find Full Text PDFOphthalmic Surg Lasers Imaging Retina
December 2024
A 35-year-old woman presented with visual acuity of 20/400 due to submacular hemorrhage 24 hours after confirmed domestic abuse with blunt trauma to the head. Surgical intervention with pars plana vitrectomy, subretinal tissue plasminogen activator (tPA) injection, and fluid-air exchange yielded prompt resolution of the pathology, regaining functional vision of 20/40 and an ability to return to work within one week. .
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