Surgery, pneumatic displacement both effective for submacular hemorrhage
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CHICAGO — Surgery and pneumatic displacement both showed benefits in the treatment of submacular hemorrhage in patients with wet age-related macular degeneration, according to a study presented here.
At the American Academy of Ophthalmology meeting, Catherine Creuzot-Garcher, MD, PhD, said there is currently no consensus on the management of submacular hemorrhage in neovascular AMD.
“We know that we need to treat these patients very quickly with an intravitreal injection of anti-VEGF,” she said. “But there have been many different treatments proposed, like pneumatic displacement, vitrectomy, intravitreal or subretinal [tissue plasminogen activator], and various combinations of all these treatments.”
Creuzot-Garcher and colleagues conducted the randomized controlled STAR trial to compare the safety and efficacy of surgical treatment with pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) vs. pneumatic displacement with intravitreal SF6 and intravitreal tPA for the treatment of submacular hemorrhage in neovascular AMD. Patients in both groups also underwent combined anti-VEGF treatment.
Creuzot-Garcher said the primary question was whether the improvement of visual acuity using PPV was superior to pneumatic displacement at 3 months based on a superiority margin of five letters. Other potential benefits of using PPV over pneumatic displacement, such as quality of life, number of anti-VEGF injections and safety, were also assessed. The analysis included 40 patients from the PPV group and 38 patients from the pneumatic displacement group.
There was no significant difference in visual acuity between the two groups at either 3 months or 6 months. Additionally, there were no quality of life differences or differences in the number of injections between the two groups.
Both procedures were safe, although pneumatic displacement tended to have recurrences of submacular hemorrhages.
“We found a good visual acuity gain in both groups, but vitrectomy was found not superior to the nonsurgical option,” Creuzot-Garcher said. “There is probably a need to consider submacular hemorrhage characteristics to better define the best therapeutic option. This is the goal of ongoing analysis.”
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Creuzot-Garcher C, et al. Surgery, tissue plasminogen activator, and antiangiogenic agents to treat submacular hemorrhage secondary to nAMD: Results of a randomized controlled trial, the STAR study. Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
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