The aim of this study was to evaluate the efficacy of a combination of tPA and anti-VEGF in the treatment of submacular haemorrhage (SMH) associated with neovascular age-related macular degeneration (nAMD). A systematic review meta-analysis following PRISMA guidelines, focusing on studies examining tPA and anti-VEGF therapy in SMH secondary to nAMD was conducted. Out of 257 records searched via database, 22 studies involving 29 diverse patient populations met the inclusion criteria. The primary efficacy outcome was the change in best-corrected visual acuity (BCVA) in LogMar scale, from baseline to one month (early outcome) and six months (late outcome) post-intervention. For studies lacking six-month data, the BCVA outcome at the next closest follow-up timepoint was used in the analysis. Secondary outcome was the incidence of successful SMH displacement. The pooled analysis demonstrated statistically significant improvements in BCVA of 0.38logMAR in the early term and 0.47logMAR in the long term. Additionally, it showed 86% success rate in displacing SMH. Meta-regression analysis was utilised to assess the relative efficacy of a surgical approach combining pars plana vitrectomy (PPV) with subretinal tPA, pneumatic displacement and anti-VEGF versus a minimally invasive strategy employing intravitreal tPA, pneumatic displacement and antiVEGF. An extended analysis of long-term outcomes mirrored that the success rate in SMH displacement was not significantly different between the two techniques (p=0.721) The study concluded that combined tPA and anti-VEGF therapy is effective in managing SMH in nAMD, significantly improving visual acuity and SMH displacement. The use of either subretinal or intravitreal tPA and anti-VEGF delivery had similar outcomes. Limitations include: (1) Study heterogenicity, ecological fallacy and publication bias. (2) Lack of information on postoperative positioning as a potential variable could have influenced treatment outcomes – this was not integrated into the meta-analysis due to lack of available information.
Submacular haemorrhage associated with nAMD: A meta-analysis and meta-regression on use of tPA and anti-VEGFs
Reviewed by Sofia Rokerya
Submacular hemorrhage during neovascular age-related macular degeneration: a meta-analysis and meta-regression on the use of tPA and anti-VEGFs.
CONTRIBUTOR
Sofia Rokerya
MBBS MRCOphth FRCSI, King's College University Hospital, UK.
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