다량의 당뇨성 황반전출혈에 대한 야그레이저와 조직형플라스미노젠 활성제의 병합치료 효과

Effects of Neodymium:YAG Laser and Tissue Plasminogen Activator on Massive Diabetic Premacular Hemorrhage

Purpose: To investigate the combined therapeutic effects of Neodymium:YAG (Nd:YAG) laser membranotomy and intravitreal tissue plasminogen activator (tPA) on massive diabetic premacular hemorrhage. Methods: The authors performed Nd:YAG laser membranotomy on the hemorrhagic membrane of premacular hemorrhages and injected tPA (25 ?g) into the vitreous cavity of 5 eyes with massive diabetic premacular hemorrhage. Each time, 0.2 ml of perfluoropropane (C3F8) gas was also injected. Results: After Nd:YAG laser membranotomy and tPA injection, the patients’ vision recovered within 4 weeks and the hemorrhages were completely absorbed within 8 weeks. Visual acuity at the last visit had improved to a mean of 10 lines (8-13 lines) on ETDRS charts for all cases. There were no associated ophthalmic complications. Also, there were no cases that required vitrectomy. Conclusions: Combined therapy of Nd:YAG laser membranotomy and tPA injection with an expansive gas is a good alternative method to observation or simple Nd:YAG laser treatment for resolution of premacular hemorrhages in proliferative diabetic retinopathy patients, and may allow for faster resolution of hemorrhages without the complications of vitrectomy.