Vitrectomy and Subretinal Injection of Tissue Plasminogen Activator for Large Submacular Hemorrhage Secondary to AMD

Abstract

To evaluate the efficacy and safety of pars plana vitrectomy (PPV) with subretinal injection of tissue plasminogen activator (tPA) for the treatment of large submacular hemorrhage (SMH) secondary to age-related macular degeneration (AMD), and identify parameters correlated with the visual prognosis. Thirty-one eyes that underwent PPV with subretinal tPA injection for large SMH secondary to AMD were included in this retrospective study. Main outcome measure was improvement in at least one line in visual acuity (VA). Improvement in VA was achieved in 14 (45.2%) patients. These patients had a significantly worse VA at presentation than patients who did not improve (p = 0.05). Central retinal thickness and earlier intervention were not correlated with the final visual prognosis. Postoperative complications included retinal detachment (19.3%), recurrent SMH (6.4%), and elevated intraocular pressure (6.4%). The VA at presentation is the most significant preoperative parameter associated with improvement in VA. A cutoff value of counting fingers VA is suggested, as patients with better VA at presentation did not benefit from surgery.