Submacular hemorrhage during neovascular age-related macular degeneration: a meta-analysis and meta-regression on the use of tPA and anti-VEGFs.

IF 2.1 4区医学 Q2 OPHTHALMOLOGY Ophthalmologica Pub Date : 2024-03-29 DOI:10.1159/000537939

Daniele Veritti, Valentina Sarao, Deborah Martinuzzi, Sara Menzio, Paolo Lanzetta

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Abstract

Background: Submacular hemorrhage (SMH) associated with neovascular age-related macular degeneration (nAMD) precipitates rapid visual decline and impacts quality of life. Treatments vary, but combined recombinant tissue plasminogen activator (tPA) and anti-vascular endothelial growth factor (anti-VEGF) therapy has gained prominence as a viable treatment option.

Objectives: This study aims to evaluate the efficacy of the combination of tPA and anti-VEGF.

Methods: We conducted a systematic review meta-analysis following PRISMA guidelines, focusing on studies examining tPA and anti-VEGF therapy in SMH secondary to nAMD. Outcomes measured were change in best-corrected visual acuity (BCVA) and success rate of SMH displacement. Meta-regression assessed the relative efficacy of intravitreal and subretinal delivery.

Results: Out of 257 initial reports, 22 studies involving 29 patient populations met inclusion criteria. Our analysis showed significant improvement in BCVA and a high rate of successful SMH displacement with combined tPA and anti-VEGF therapy. No significant differences were found between subretinal and intravitreal tPA administration. Furthermore, when evaluating the effects of subretinal versus intravitreal anti-VEGF administration in patients treated with subretinal tPA, the results indicated similar efficacy.

Conclusions: Combined tPA and anti-VEGF therapy is effective in managing SMH in nAMD patients, significantly improving visual acuity and SMH displacement. The location of tPA and anti-VEGF delivery did not significantly impact outcomes.

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新生血管性老年黄斑变性期间的黄斑下出血：关于使用 tPA 和抗血管内皮生长因子的荟萃分析和荟萃回归。

背景：与新生血管性老年黄斑变性（nAMD）相关的黄斑下出血（SMH）会导致视力急剧下降并影响生活质量。治疗方法各不相同，但重组组织浆蛋白酶原激活剂（tPA）和抗血管内皮生长因子（anti-VEGF）联合疗法作为一种可行的治疗方案已逐渐受到重视：本研究旨在评估 tPA 和抗血管内皮生长因子联合疗法的疗效：我们按照 PRISMA 指南进行了一项系统性综述荟萃分析，重点研究了 tPA 和抗血管内皮生长因子疗法对继发于 nAMD 的 SMH 的治疗效果。衡量的结果是最佳矫正视力（BCVA）的变化和SMH移位的成功率。元回归评估了玻璃体内给药和视网膜下给药的相对疗效：结果：在 257 份初步报告中，有 22 项涉及 29 个患者群体的研究符合纳入标准。我们的分析表明，联合使用 tPA 和抗血管内皮生长因子疗法后，BCVA 有明显改善，SMH 置换成功率很高。视网膜下和玻璃体内 tPA 给药之间没有发现明显差异。此外，在评估视网膜下 tPA 与玻璃体内抗血管内皮生长因子治疗的效果时，结果显示疗效相似：结论：tPA和抗血管内皮生长因子联合疗法能有效控制nAMD患者的SMH，显著改善视力和SMH移位。tPA和抗血管内皮生长因子的给药位置对疗效无明显影响。

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来源期刊

Ophthalmologica 医学-眼科学

CiteScore

5.10

自引率

3.80%

发文量

审稿时长

3 months

期刊介绍： Published since 1899, ''Ophthalmologica'' has become a frequently cited guide to international work in clinical and experimental ophthalmology. It contains a selection of patient-oriented contributions covering the etiology of eye diseases, diagnostic techniques, and advances in medical and surgical treatment. Straightforward, factual reporting provides both interesting and useful reading. In addition to original papers, ''Ophthalmologica'' features regularly timely reviews in an effort to keep the reader well informed and updated. The large international circulation of this journal reflects its importance.