| 본문 : Purpose: To compare the effects of three common treatment modalities for a submacular hemorrhage (SMH) due to exudative age-related macular degeneration.
Method: Seventy-seven patients with exudative age-related macular degeneration and acute SMH greater than 250 ㎛ were divided into three groups: small-sized, medium-sized, and large-sized SMH. Patients received anti-VEGF monotherapy, pneumatic displacement (PD) with intravitreal anti-VEGF ± tissue plasminogen activator (tPA), or vitrectomy with a subretinal tPA injection. Outcomes were determined by degree of displacement or absroption of SMH, Snellen visual acuity, freqency of postoperative anti-VEGF injections, incidence of recurrent SMH or breakthrough vitreous hemorrahge, and complication.
Results: When comparing three groups during the follow-up, in small-sized SMH, VA gradually increased in all treatment modalities. In medium-sized SMH, VA improved only in two treatment modalities except for anti-VEGF monotherapy. In large-sized SMH, only in the subretinal tPA group, VA improved at final visit (p=0.032) with higher complete displacement rate of SMH (85.7% vs 25%). Visual outcome (reading ability, <0.4 LogMAR) was associated with symptom duration and thickness of SMH after adjustment.
Conclusion: Our findings demonstrated that visual improvement can be expected through rapid and complete displacement of hemorrhage regardless of bleeding size. Vitrectomy with subretinal tPA and pneumatic displacement is favored at our institution and may be more advantageous than anti-VEGF injections alone in managing patients with the larger SMH from AMD with poorer VA.
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