ArticleSAGE open medicine2025
Management of submacular hemorrhage secondary to age-related macular degeneration with vitrectomy and subretinal tissue plasminogen activator injection: Outcomes and prognostic factors.
Article in SAGE open medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To evaluate the efficacy of pars plana vitrectomy combined with subretinal tissue plasminogen activator injection, pneumatic displacement, and intraoperative intravitreal antivascular endothelial growth factor therapy for treating submacular hemorrhage secondary to polypoidal choroidal vasculopathy or neovascular age-related macular degeneration. Methods: This retrospective study enrolled 28 patients who were diagnosed with submacular hemorrhage secondary to polypoidal choroidal vasculopathy or neovascular age-related macular degeneration, all of whom received a minimum follow-up period of 6 months. Key preoperative parameters, such as submacular hemorrhage height and diameter, tissue plasminogen activator dosage, and hemorrhage duration, were documented. Postoperative outcomes evaluated included the degree of submacular hemorrhage displacement, visual acuity changes, incidence of complications, and the requirement for additional intravitreal antivascular endothelial growth factor injections during the follow-up period. Results: The mean patient age was 66.71 ± 10.62 years. The mean visual acuity progressively improved from a preoperative logMAR of 1.57 ± 0.64 to 1.26 ± 0.67, 1.15 ± 0.59, 1.14 ± 0.55, and 1.12 ± 0.56 at postoperative months 1, 3, and 6, respectively. Complete hemorrhage displacement was achieved in 85.71% (24/28) of cases. Preoperative hemorrhage duration was significantly negatively correlated with postoperative best-corrected visual acuity at 1 month ( Conclusions: Pars plana vitrectomy with tissue plasminogen activator subretinal injection, pneumatic displacement, and intraoperative vitreous antivascular endothelial growth factor injection represents a safe and effective approach for managing submacular hemorrhage secondary to polypoidal choroidal vasculopathy and neovascular age-related macular degeneration. The duration of submacular hemorrhage emerges as the most critical prognostic factor for final visual outcomes. Patients with hemorrhage duration exceeding 14 days demonstrate a significantly reduced likelihood of achieving favorable visual outcomes.
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