Comparison of different treatment options in submacular haemorrhage
Abstract Background/aims Submacular haemorrhages (SMH) cause significant visual impairment. Until now, the comparative effectiveness of different treatment approaches remains inconclusive without clear treatment guidelines. The aim of our study was to evaluate the effectiveness of 5 surgical treatme...
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2024-12-01
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| Series: | BMC Ophthalmology |
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| Online Access: | https://doi.org/10.1186/s12886-024-03794-y |
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| author | Anna Hillenmayer Christian M. Wertheimer Marlene Hillenmayer Laura D. Strehle Lennart M. Hartmann Efstathios Vounotrypidis Armin Wolf |
| author_facet | Anna Hillenmayer Christian M. Wertheimer Marlene Hillenmayer Laura D. Strehle Lennart M. Hartmann Efstathios Vounotrypidis Armin Wolf |
| author_sort | Anna Hillenmayer |
| collection | DOAJ |
| description | Abstract Background/aims Submacular haemorrhages (SMH) cause significant visual impairment. Until now, the comparative effectiveness of different treatment approaches remains inconclusive without clear treatment guidelines. The aim of our study was to evaluate the effectiveness of 5 surgical treatment modalities in terms of visual prognosis and success rate. Methods This retrospective study included 201 patients with SMH. Primary endpoint was best corrected visual acuity (BCVA), secondary endpoints included haemorrhage size and complications. Group 1 was treated with pneumatic displacement and rtPA-injection. Group 2 followed the "Manchester protocol" with rtPA-injection and—if needed—a standardised secondary procedure with pars plana vitrectomy (ppV) and subretinal rtPA. Group 3 underwent vitrectomy with subretinal rtPA, group 4 vitrectomy only and group 5 received subretinal lavage. Results Baseline characteristics were a mean age of 79 years and a follow-up of 4.6 months. Pre-intervention BCVA of 1.7 logMAR improved to 1.4 logMAR at follow-up. A gain of > 0.2 logMAR was achieved in 47% of patients, while 20% lost > 0.2 logMAR. Only group 2 achieved a statistically significant visual gain. While group 5 was statistically larger in haemorrhage size preoperatively (p < 0.05), all groups were statistically equal in SMH size at follow-up. Complications led to additional interventions in 20% of patients. Conclusions No significant change in visual prognosis could be achieved depending on the intervention. As more invasive techniques seem to lack the benefit of a better postoperative prognosis while carrying higher risks, it may be beneficial considering a less invasive option first. |
| format | Article |
| id | doaj-art-09d7e18b950d44f8960841d79b4dc473 |
| institution | OA Journals |
| issn | 1471-2415 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj-art-09d7e18b950d44f8960841d79b4dc4732025-08-20T02:35:47ZengBMCBMC Ophthalmology1471-24152024-12-012411910.1186/s12886-024-03794-yComparison of different treatment options in submacular haemorrhageAnna Hillenmayer0Christian M. Wertheimer1Marlene Hillenmayer2Laura D. Strehle3Lennart M. Hartmann4Efstathios Vounotrypidis5Armin Wolf6Department of Ophthalmology, University of UlmDepartment of Ophthalmology, University of UlmDepartment of Ophthalmology, University of UlmDepartment of Ophthalmology, University of UlmDepartment of Ophthalmology, University of UlmDepartment of Ophthalmology, University of UlmDepartment of Ophthalmology, University of UlmAbstract Background/aims Submacular haemorrhages (SMH) cause significant visual impairment. Until now, the comparative effectiveness of different treatment approaches remains inconclusive without clear treatment guidelines. The aim of our study was to evaluate the effectiveness of 5 surgical treatment modalities in terms of visual prognosis and success rate. Methods This retrospective study included 201 patients with SMH. Primary endpoint was best corrected visual acuity (BCVA), secondary endpoints included haemorrhage size and complications. Group 1 was treated with pneumatic displacement and rtPA-injection. Group 2 followed the "Manchester protocol" with rtPA-injection and—if needed—a standardised secondary procedure with pars plana vitrectomy (ppV) and subretinal rtPA. Group 3 underwent vitrectomy with subretinal rtPA, group 4 vitrectomy only and group 5 received subretinal lavage. Results Baseline characteristics were a mean age of 79 years and a follow-up of 4.6 months. Pre-intervention BCVA of 1.7 logMAR improved to 1.4 logMAR at follow-up. A gain of > 0.2 logMAR was achieved in 47% of patients, while 20% lost > 0.2 logMAR. Only group 2 achieved a statistically significant visual gain. While group 5 was statistically larger in haemorrhage size preoperatively (p < 0.05), all groups were statistically equal in SMH size at follow-up. Complications led to additional interventions in 20% of patients. Conclusions No significant change in visual prognosis could be achieved depending on the intervention. As more invasive techniques seem to lack the benefit of a better postoperative prognosis while carrying higher risks, it may be beneficial considering a less invasive option first.https://doi.org/10.1186/s12886-024-03794-ySubmacular haemorrhageRtPAMacular degenerationMacular haemorrhagePneumatic displacementSubretinal haemorrhage |
| spellingShingle | Anna Hillenmayer Christian M. Wertheimer Marlene Hillenmayer Laura D. Strehle Lennart M. Hartmann Efstathios Vounotrypidis Armin Wolf Comparison of different treatment options in submacular haemorrhage BMC Ophthalmology Submacular haemorrhage RtPA Macular degeneration Macular haemorrhage Pneumatic displacement Subretinal haemorrhage |
| title | Comparison of different treatment options in submacular haemorrhage |
| title_full | Comparison of different treatment options in submacular haemorrhage |
| title_fullStr | Comparison of different treatment options in submacular haemorrhage |
| title_full_unstemmed | Comparison of different treatment options in submacular haemorrhage |
| title_short | Comparison of different treatment options in submacular haemorrhage |
| title_sort | comparison of different treatment options in submacular haemorrhage |
| topic | Submacular haemorrhage RtPA Macular degeneration Macular haemorrhage Pneumatic displacement Subretinal haemorrhage |
| url | https://doi.org/10.1186/s12886-024-03794-y |
| work_keys_str_mv | AT annahillenmayer comparisonofdifferenttreatmentoptionsinsubmacularhaemorrhage AT christianmwertheimer comparisonofdifferenttreatmentoptionsinsubmacularhaemorrhage AT marlenehillenmayer comparisonofdifferenttreatmentoptionsinsubmacularhaemorrhage AT lauradstrehle comparisonofdifferenttreatmentoptionsinsubmacularhaemorrhage AT lennartmhartmann comparisonofdifferenttreatmentoptionsinsubmacularhaemorrhage AT efstathiosvounotrypidis comparisonofdifferenttreatmentoptionsinsubmacularhaemorrhage AT arminwolf comparisonofdifferenttreatmentoptionsinsubmacularhaemorrhage |