Pars plana vitrectomy with tissue plasminogen activator for traumatic submacular hemorrhage

To evaluate visual outcomes of pars plana vitrectomy (PPV) combined with tissue plasminogen activator (tPA)-induced clot lysis and pneumatic displacement for submacular hemorrhage (SMH) in a cohort of closed-globe trauma patients.

A retrospective, multicenter interventional case series involving 7 eyes of 7 patients who underwent PPV with subretinal tPA administration for SMH secondary to closed-globe injury were conducted. The primary outcome measure was the change in Snellen visual acuity.

The mean age of patients was 32y (range: 21-51y), with a mean follow-up duration of 4.6mo (range: 1.1-14.9mo). The average best-corrected visual acuity (BCVA) was 20/1020 at baseline and 20/114 at the final visit, respectively (P=0.025). Preoperative BCVA was not a significant predictor of final BCVA (r=0.102, P=0.827). Final BCVA did not differ significantly between patients who underwent PPV within 14d of symptom onset and those who underwent surgery after 14d (P=0.57). All eyes received SF₆ or C₃F₈ gas tamponade.

Surgical intervention involving tPA-mediated clot lysis and pneumatic displacement may yield visual benefits in trauma-induced SMH without underlying retinal vascular disease; however, larger prospective studies are warranted to confirm these findings.