맥락막신생혈관을 동반한 광범위한 망막하출혈환자에 대한 삼중치료 효과 = The Effect of Triple Therapy on Patients with Subretinal Hemorrhage Accompanied by Choroidal Neovascularization

다국어 초록 (Multilingual Abstract)

Purpose: To presents the effect of triple therapy including C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy on patients with subretinal hemorrhage accompanied by choroidal neovascularization. Methods: Twelve eyes of 12 patients suffering from subretinal hemorrhage accompanied by choroidal neovascularization with onset of the symptom within a week prior to three-day prone positioning after C3F8 gas injection were included in the present study. Next, intravitreal anti-VEGF injection and photodynamic therapy was performed. Then, within two months, intravitreal bevacizumab or ranibizumab injection was performed. Results: After stabilization of the submacular hemorrhagic lesion, ten eyes of ten patients showed improved visual acuity, one eye showed no improvement, and decreased visual acuity developed in one patient. LogMAR visual acuity improved after the initial treatment from 1.05 ± 0.43 to 0.74 ± 0.58 and 0.53 ± 0.51 at three and six months, respectively. The improvement was considered to be clinically significant. Conclusions: An appropriate regimen for treating broad submacular hemorrhage accompanied by choroidal neovascularization has not been established. The authors of the patients had obtained positive results from C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy. In the future, additional studies should be conducted. J Korean Ophthalmol Soc 2011;52(4):442-447

참고문헌 (Reference)

1 Avery RL, "qNatural history of subfoveal subretinal hemorrhage in age-related macular degeneration" 16 : 183-189, 1996

2 Berrocal MH, "Variations in the clinical course of submacular hemorrhage" 124 : 486-493, 1996

3 Kamei M, "Tissue Tissue plasminogen activator in the treatment of vitreoretinal diseases" 15 : 44-50, 2000

4 Sanders D, "The toxicity of intravitreal whole blood and hemoglobin" 197 : 255-267, 1975

5 Macular Photocoagulation Study Group, "Subfoveal neovascular lesions in age related macular degeneration,In Guidelines for evaluation and treatment in the macular photocoagulation study" 109 : 1242-1257, 1991

6 Johnson MW, "Retinal toxicity of recombinant tissue plasminogen activator in the rabbit" 108 : 259-263, 1990

7 Stephen JR, "Retina" Mosby 137-152, 2005

8 Brown DM, "Ranibizumab versus verteporfin for neovascular age-related macular degeneration" 355 : 1432-1444, 2006

9 Bressler NM, "Photodynamic therapy of subfoveal choroidal neovascularization in age related macular degeneration with verteporfin" 119 : 198-207, 2001

10 Scupola A, "Natural history of macular subretinal hemorrhage in age-related macular degeneration" 213 : 97-102, 1999

11 Hassan AS, "Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement" 106 : 1900-1906, 1999

12 Meier P, "Management of submacular hemorrhage by tissue plasminogen activator and SF (6) gas injection" 96 : 643-647, 1999

13 Hesse L, "Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas" 237 : 273-277, 1999

14 Hattenbach LO, "Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions" 108 : 1485-1492, 2001

15 Bashshur ZF, "Intravitreal bevacizumab vs verteporfin photodynamic therapy for neovascular age related macular degeneration" 125 : 1357-1361, 2007

16 Emerson MV, "Intravitreal bevacizumab (Avastin) treatment of neovascular age related macular degeneration" 27 : 439-444, 2007

17 Toth CA, "Fibrin directs early retinal damage after experimental subretinal hemorrhage" 109 : 723-729, 1991

18 Bennett SR, "Factors prognostic of visual outcome in patients with subretinal hemorrhage" 109 : 33-37, 1990

19 Bennett SR, "Factors prognostic of visual outcome in patients with subretinal hemorrhage" 109 : 33-37, 1990

20 Ferrara N, "Development of ranibizumab, an anti vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age related macular degeneration" 26 : 859-870, 2006

21 Fung AE, "An optical coherence tomography guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age related macular degeneration" 143 : 566-583, 2007