Predictors of visual outcomes after vitrectomy for submacular hemorrhage due to polypoidal choroidal vasculopathy

To evaluate visual outcomes after vitrectomy-based displacement of submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV) using swept-source optical coherence tomography (SS-OCT), and to identify preoperative factors associated with favorable postoperative best-corrected visual acuity (BCVA).

This retrospective study included 43 eyes with SMH secondary to PCV that underwent vitrectomy with subretinal tissue plasminogen activator injection and air/gas tamponade. All eyes were followed for at least 6 months. SS-OCT was used to assess continuity of external limiting membrane (ELM) and ellipsoid zone, central retinal thickness (CRT), the presence or absence of pigment epithelial detachment (PED), SMH height and diameter, and contrast-to-noise ratio, as a parameter reflecting the degree of SMH solidification. Correlation and multiple regression analyses were performed to evaluate associations between preoperative parameters and final BCVA.

Mean SMH height decreased from 654.6 ± 307.5 μm preoperatively to 29.1 ± 73.7 μm at 1 month (P < 0.001). BCVA significantly improved from 0.97 ± 0.56 at baseline to 0.64 ± 0.51 at 1 month and 0.55 ± 0.58 at the final visit (both P ≤ 0.004). Preoperative ELM continuity, better baseline BCVA, lower SMH height, the absence of foveal PED, and lower CRT were significantly associated with a more favorable final BCVA (all P < 0.05). Multiple regression analyses identified preoperative ELM continuity and baseline BCVA as independent predictors of good final BCVA (P < 0.001, P < 0.05, respectively).

In SMH secondary to PCV, vitrectomy-based SMH displacement achieved effective and sustained visual improvement. Preoperative ELM continuity and better visual acuity were strongly predictive of a favorable postoperative BCVA.