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Vitrectomy with Subretinal Tissue Plasminogen Activator for Submacular Hemorrhage: A Multicenter Retrospective
Somnath Chakraborty1, Jay U Sheth2, Santanu Ganguly1
1Department of Retina Services, Retina Institute of Bengal, Siliguri, India.
Purpose:
To evaluate visual and anatomical outcomes of pars plana vitrectomy (PPV) with subretinal tissue plasminogen activator (tPA) and gas or air tamponade for large submacular haemorrhage (SMH>4 disc diameters) of varied etiologies and assess postoperative anti-vascular endothelial growth factor (anti-VEGF) requirements in a multicenter real-world cohort.
Patients And Methods:
This retrospective, two-center study included 32 eyes undergoing PPV with subretinal tPA (25-50 µg/0.1-0.2 mL) and SF6 or air tamponade, followed for ≥6 months. The primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included central macular thickness (CMT), SMH dimensions, subretinal/intraretinal fluid (SRF/IRF) status, intraocular pressure (IOP), and anti-VEGF use.
Results:
Mean patient age was 60.8 ± 19.1 years; etiologies included polypoidal choroidal vasculopathy (PCV; 53.1%), neovascular age-related macular degeneration (nAMD; 28.1%), trauma (12.5%), and retinal artery macroaneurysm (RAM; 6.3%). BCVA improved significantly from 1.13 ± 0.30 to 0.56 ± 0.26 logMAR (P<0.001), with 55.2% gaining ≥3 lines. CMT reduced from 501 ± 219 to 276 ± 70 µm (P<0.001), and SMH size decreased from 5 ± 2 to 0 disc diameters by 6 months. SRF resolved in 65.65% of eyes (P<0.001), while IRF remained stable (P=0.51). IOP normalized after a transient 1-month rise. Mean anti-VEGF use was 1.2 injections/eye (bevacizumab 88.2%, brolucizumab 11.8%). No major complications occurred; one transient vitreous hemorrhage and three cataract progressions were noted.
Conclusion:
PPV with subretinal tPA achieved rapid hemorrhage clearance, significant visual gain, and durable anatomical restoration with minimal complications and limited anti-VEGF need. It offers an effective, safe option for large SMH across etiologies, enabling timely foveal recovery and improved long-term functional outcomes.
