Predictors of 3-month and 1-year visual outcomes after vitrectomy with subretinal tissue plasminogen activator injection for submacular hemorrhage

Abstract

PURPOSE: To investigate factors associated with 3-month or 1-year best-corrected visual acuity (BCVA) after vitrectomy with subretinal tissue plasminogen activator (tPA) injection for submacular hemorrhage (SMH) and to identify the predictors of early displacement. METHODS: This prospective cohort study included consecutive eyes with SMH complicating neovascular age-related macular degeneration (nAMD) or retinal macroaneurysm (RMA) that underwent vitrectomy with subretinal tPA injection and were followed up for at least 3 months. We identified parameters correlated with 3-month BCVA, 1-year BCVA, and 2-week displacement grade (0-3). RESULTS: Twenty-nine eyes of 29 patients (73.1 ± 8.4 years; nAMD, 25 eyes) were included. Logarithm of the minimum angle of resolution (logMAR) BCVA improved 3 months after the surgery (baseline, 0.76 [20/115] ± 0.35; 3-month, 0.51 [20/65] ± 0.32; P = 0.006). In multivariable analyses, 1-year logMAR BCVA correlated with age (P = 0.007, β = 0.39) and SMH recurrence within 1 year after surgery (P <0.001, β = 0.65). Two-week displacement grade correlated with the contrast-to-noise ratio (CNR) of SMH (P = 0.001, β = -0.54). Macular hole occurred in three eyes (10%) with small SMH size and was closed in all eyes via additional vitrectomy with an inverted internal limiting membrane flap technique. CONCLUSIONS: The recurrence of SMH negatively affected the 1-year visual outcome after vitrectomy with subretinal tPA injection for SMH. The CNR was a useful predictor of early SMH displacement but not of 1-year BCVA. Further research is necessary to determine the optimal treatment to prevent SMH recurrence.