بررسی اثر تزریق داخل ویتره آواستین و ترکیب آواستین و tPA بر حدت بینایی و ضخامت ماکولا در بیماران با دژنراسیون ماکولای وابسته به سن نیوواسکولار

Background: Hemorrhagic choroidal neovascularization in patients with age-related macular degeneration (AMD) is a serious complication that if left untreated may cause severe consequences in patients’ visual acuity. Although there is not a standard treatment for this condition, intravitreal tissue plasminogen activator (t-PA) with gas is a classic and highly enthusiastic approach. Using this treatment, however, may become in vain in long term because of the progression of the underlying pathology. So, some authors have proposed using anti-vascular endothelial growth factor (VEGF) agents such as Avastin in these patients. The aim of this study is to compare outcomes of treatment with intravitreal t-PA or t-PA plus Avastin.  Methods & Materials: A total of 43 patients with AMD-related hemorrhagic choroidal neovascularization were randomized in two groups, receiving either intravitreal 1.25 Avastin (n=21) or intravitreal 1.25 Avastin plus 50 microgram t-PA (n=22). Visual acuity (using LogMar) and central macular thickness were measured at months 2 and 6 post-treatment and compared between the two groups. Results: Thirteen males and 9 females with the median age of 74 years (combined treatment group) were compared with 12 males and 9 females with the median age of 73 years (single treatment group) (p=0.89 and 0.81, respectively). Median percent changes in visual acuity were 4.3% decrease in the combined treatment group and 8.6% in the single treatment group at month 2 and 10% in both groups at month 6. Visual acuity ameliorated significantly in both groups 6 months after treatment, but there was no significant difference between the two groups in this regard (p=0.93 and p=0.96 at months 2 and 6 post-treatment). Median percent changes in central macular thickness were 16.9% decrease in the combined treatment group and 16.8% in the single treatment group at month 2 and 19.1% in combined treatment and 18.2% in single treatment group at month 6. Central macular thickness decreased significantly in both groups 6 months after treatment, but again there was no significant difference between the two groups in this regard (p=0.97 and p=0.79 at months 2 and 6 post-treatment). Conclusion: Both therapeutic approaches were effective in treating AMD-related hemorrhagic choroidal neovascularization after six months, but there was no significant difference between the two methods in this regard.