Intravitreous Recombinant Tissue Plasminogen Activator and Gas to Treat Submacular Hemorrhage in Age-related Macular Degeneration

玻璃體內注射 rTPA 及氣體治療老年性黃斑部退化的黃斑部下出血

蔡三章(San-Chang Tsai) ； 林正明(Jane-Ming Lin) ； 陳幸宜(Hsin-Yi Chen)

《The Kaohsiung Journal of Medical Sciences》 19卷12期 (2003/12) Pp. 608-616

摘要

本篇評估玻璃體內注射rTPA及氣體，用於治療老年性黃斑部退化引起的黃斑部下出血的安全性及效用。從89年1月到91年4月，我們共收集了因老年性黃斑部退化所引起的黃斑部下出血的15位病人，所有的病人均接受玻璃體內注射100μg rTPA及0.3mL的C3F8。手術後病人先平躺4小時，之後維持趴睡姿勢4天。經過6-19個月的追蹤，我們評估出血吸收及視力恢復的情形。結果顯示，在15個病人中，出血完全位移的有12人，佔80%；出血部分位移的有3人，佔20%。術後最佳視力，全部病人均有改善，有7人（47%）改善大於2行。最終視力，有12人改善，有2人維持穩定及1人變壞。同時我們的結果也顯示出：出血期間≦21天有較好的術後最佳視力的進步及最終視力的改善（p=0.0256及0.044）。在併發症方面，除了有2位病人在術後第一天產生輕微玻璃體出血外，其他沒有發現rTPA產生的視網膜毒性。玻璃體內注射rTPA及氣體對於老年性黃斑部退化引起的黃斑部下出血，視力方面改善是安全而且有效的。雖然最終的視力有時會受到自然疾病進展的影響，但是藉由這個方便簡單的方法，的確能使視力在一段長時間的追蹤下有明顯的改善與進步。

關鍵字

黃斑部下出血 ； 老年性黃斑部退化

並列摘要

We evaluated the safety and efficacy of intravitreous recombinant tissue plasminogen activator (rTPA) and gas for the treatment of submacular hemorrhage in age-related macular degeneration (ARMD). From January 2000 to April 2002, we enrolled 15 patients with submacular hemorrhage secondary to ARMD. All patients received 100 μg rTPA and 0.3 mL perfluoropropane intravitreously. Postoperatively, all patients were kept in a supine position for 4 hours followed by a face-down position for 4 days. Anatomic and functional results were evaluated during a follow-up period of 6 to 19 months. Submacular blood was completely displaced in 12 patients (80%) and partially in three (20%). Best postoperative visual acuity improved in all 15 eyes; in seven eyes (47%), the improvement was two or more lines. Final visual acuity improved in 12 eyes, remained stable in two eyes, and worsened in one eye. Onset of hemorrhage within 21 days was associated with better gains of lines in best postoperative (p = 0.0256) and final visual acuity (p = 0.044). Although two patients developed mild breakthrough vitreous hemorrhage within 1 day after treatment, no rTPA-related retinal toxicity was observed. Intravitreous injections of rTPA and gas are safe and effective in improving visual acuity in patients with submacular hemorrhage secondary to ARMD. Although the final visual outcome is often limited by the progression of the disease, significant and stable visual recovery over an extended follow-up period is possible using this easy and convenient technique.

並列關鍵字

recombinant tissue plasminogen activator ； submacular hemorrhage ； age-related macular degeneration