Pneumatic displacement and intravitreal anti-vascular endothelial growth factor, with or without intravitreal tissue plasminogen activator, injection for submacular hemorrhage

Abstract

Purpose: To evaluate the outcomes of intravitreal gas and anti-vascular endothelial growth factor (VEGF), with or without tissue plasminogen activator (tPA), injection for submacular hemorrhage (SMH). Methods: We retrospectively enrolled patients with SMH treated with intravitreal gas and anti-VEGF, with or without tPA (tPA and non-tPA groups, respectively), injection between 2014 and 2021 and data were collected at the preoperative visit and at 1-, 3-, 6-, and 12-month follow-ups. The primary outcome was the final best-corrected visual acuity (BCVA), and the secondary outcomes were central subfield thickness (CST), degree of blood displacement, and incidence of vitreous hemorrhage (VH). Results: Herein, 38 eyes received intravitreal gas, anti-VEGF, and tPA injections whereas 89 received intravitreal gas and anti-VEGF injections. At 12 months, no significant intergroup difference was detected (p=0.94), except the slightly greater CST change in the non-tPA group (p=0.03). Complete SMH displacement occurred in 35 (tPA=92.1%) and 89 (non-tPA=89.9%) eyes, with higher VH incidence in the non-tPA group (OR 7.03, p=0.004). Conclusion: In pneumatic displacement combined with anti-VEGF therapy in SMH, adjunctive tPA use did not alter the visual and anatomical outcomes although the VH risk in large SMH was reduced.