Efficacy of vitrectomy combined with subretinal injection of tissue plasminogen activator on macular hemorrhage

Objective

To observe the efficacy of vitrectomy combined with subretinal injection of tissue plasminogen activator (t-PA) in the treatment of macular hemorrhage (SMH).

Method

An observational case series study was performed.Twelve eyes of 12 SMH patients diagnosed in Tianjin Medical University Eye Hospital were included from February 2022 to November 2022, including 11 eyes of polypoid choroidal vascular disease (PCV) and 1 eye of retinal artery aneurysm.There were 5 males and 7 females, aged 56 to 78 years old, with an average age of (65.67±8.09) years.Two eyes had intraocular lenses and 10 eyes were with cataracts.Nine cases had hypertension and 2 cases had diabetes.The duration of SMH was 2 to 25 days, with an average of (14.67±8.03) days.Vitrectomy combined with subretinal injection of t-PA was performed in the 12 eyes.All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect ophthalmoscopy, optical coherence tomography (OCT), and ultra-wide-filed imaging examinations before and 1, 3, 6 months after surgery.The central retinal thickness (CRT) was examined using an OCT instrument.The postoperative ocular conditions and the occurrence of adverse effects were observed.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2022JS-05).Written informed consent was obtained from each patient before surgery.

Results

The preoperative, 1-, 3-, and 6-month postoperative average BCVA (LogMAR) of the affected eye was 1.58±0.63, 1.12±0.49, 1.07±0.44, and 0.59±0.19, respectively, showing a statistically significant overall difference (F=14.435, P<0.001).The BCVA at 6 months after surgery was significantly better than that before surgery (P<0.001).The preoperative, 1-, 3-, and 6-month postoperative average CRT of the affected eye was (606.25±204.67), (379.83±92.05), (313.75±60.87), and (267.75±73.07)μm, respectively, showing a statistically significant overall difference (F=27.720, P<0.001).The CRT at 1, 3, 6 months after surgery were significantly thinner than that before surgery (all at P<0.001).One eye had suprachoroidal hemorrhage 3 months after surgery, and 6 eyes received intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs due to recurrent PCV during follow-up, with a total of 16 injections.The average number of anti-VEGF injections at 1, 3, and 6 months after surgery was (0.3±0.5), (1.3±1.4), and (2.7±2.0) times, respectively.

Conclusions

In the treatment of SMH, vitrectomy combined with subretinal injection of t-PA can improve BCVA, reduce CRT, reduce retinal damage from blood clots, and promote early postoperative visual recovery.It is a safe and effective surgical procedure.

Polypoidal choroidal vasculopathy; Tissue plasminogen activator; Vitrectomy; Submacular hemorrhage; Subretinal injection; Efficacy