Abstract
Purpose: To evaluate the surgical outcome of subretinal tissue plasminogen activator (tPA) delivered without vitrectomy for the displacement of submacular hemorrhage (SMH). Method: A retrospective interventional cases series of consecutive patients who underwent subretinal tPA and intravitreal expansile gas without vitrectomy for SMH displacement. Concomitant injection of subretinal air and intravitreal ranibizumab and expansile gas was performed per surgeon’s discretion. Results: Seven eyes from 7 patients were included. 6 eyes (85.7%) had polypoidal choroidal vasculopathy (PCV) and 1 (14.3%) had wet age-related macular degeneration (wAMD). The median baseline visual acuity (VA) was 0.014 (range 0.005-50.1) ETDRS letters, which improved to 35 (range 26.3-65.1), 35 (range 31.0-73.9), 35 (range 35-77.3) and 35 (range 5-80.2) ETDRS letters at 1 week, 1 month, 3 months and 6 months, respectively. Visual gain of ≥5 letters was achieved in majority of patients through 6 months. Successful displacement of blood away from fovea was achieved in 100% of eyes. The rate of postoperative vitreous hemorrhage, retinal pigment epithelium tear and macular hole were 14.3% (1 patient) each. Conclusion: This novel, minimally invasive surgical technique is effective in displacing SMH and preserving vision.
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