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VITRECTOMY AND SUBRETINAL tPA INJECTION FOR SUBRETINAL HEMORRHAGE SECONDARY TO RETINAL ARTERIAL MACROANEURYSM: A
Muhammed Onur Ok1, V Levent Karabaş1, Ecem Onder Tokuc1
1Department of Ophthalmology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Retina (Philadelphia, Pa.)
|February 10, 2026
Summary
Pars plana vitrectomy with subretinal tissue plasminogen activator (tPA) injection effectively treats subretinal hemorrhage from retinal arterial macroaneurysm (RAM) rupture. Early surgery within two weeks improves visual acuity, but RPE atrophy location impacts outcomes.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Vascular Eye Disease
Background:
- Retinal arterial macroaneurysm (RAM) rupture can cause significant subretinal hemorrhage, leading to vision loss.
- Subfoveal hemorrhage poses a challenge for visual recovery due to potential damage to photoreceptors and the retinal pigment epithelium (RPE).
Purpose of the Study:
- To assess the long-term functional and anatomical results of pars plana vitrectomy (PPV) combined with subretinal recombinant tissue plasminogen activator (tPA) and gas tamponade for RAM-related subretinal hemorrhage.
- To evaluate the impact of the symptom-to-surgery interval and postoperative RPE atrophy on visual outcomes.
Main Methods:
- Retrospective analysis of 18 eyes undergoing PPV, subretinal tPA injection, and gas tamponade for subfoveal hemorrhage due to RAM rupture.
- Evaluation of best-corrected visual acuity (BCVA), central macular thickness (CMT), and complications over a minimum 12-month follow-up.
- Analysis of the relationship between symptom-to-surgery interval and visual outcomes, and the impact of RPE atrophy location.
Main Results:
- Significant improvement in mean BCVA from 20/3300 to 20/140 (p < 0.001) at 12 months.
- Surgical intervention within 14 days correlated with better BCVA gains.
- Subfoveal RPE atrophy (38.9%) was associated with worse visual outcomes (p = 0.02); overall postoperative RPE atrophy occurred in 77.8% of patients.
Conclusions:
- PPV with subretinal tPA and gas tamponade is effective for RAM-related subretinal hemorrhage, yielding significant visual acuity improvements.
- Timely surgical intervention (within two weeks) is crucial for optimal visual recovery.
- Postoperative RPE atrophy location is a critical prognostic factor influencing long-term visual outcomes.
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