Early subretinal t-PA associated with vitrectomy in patients with subretinal hemorrhage, a pilot study

PurposeThe study aims to assess the outcomes of introducing tissue plasminogen activator (t-PA) for massive subretinal hemorrhage (SRH) during pars plana vitrectomy (PPV).MethodsThis consecutive, retrospective, non-randomized study evaluated 11 eyes with massive SRH. The post-operative follow-up was assessed after 3- and 6 months from the surgery, evaluating the Best-corrected visual acuity (BCVA) and measured the central macular thickness (CMT). All eyes were undergoing a PPV in combination with t-PA introduction and retinal displacement, fluid-air exchange, and anti-VEGF injection.Results11 eyes were included. At baseline, the main BCVA before the surgery was very poor. At 3-month after the surgery 5 eyes (45.4%) gained two and three lines on the visual acuity chart (range 20/400-20/100), and it was remained stable at 6-month. Solely in 3 eyes the BCVA not improved in the follow-up time. Moreover, in 3 eyes (27.3%), the BCVA improved significantly (p < 0.05). Pre-surgical CMT was 596,4 ± 143,2 μm. Postoperative CMT was 288,7 ± 77,6 μm at 3-months follow-up (p < 0.05) and 263,3 ± 75,2 μm at 6-months follow-up (p < 0.05). Hemorrhage was displaced away from the fovea in all eyes. SRH recurred in only one eye.ConclusionWe suggest that timely intervention in massive-sized SRH may play a crucial role in limiting the extent of damage and preventing poor visual outcomes. It is also important to note that prompt treatment may help preserve foveal anatomy and limit the structural damage associated with this condition.