Vitrectomy-Assisted Intravitreal Tissue Plasminogen Activator and SF6 Gas Injection on Submacular Hemorrhage

Purpose: To evaluate the results of vitrectomy-assisted intravitreal tissue plasminogen activator (tPA) and gas injection in the treatment of submacular hemorrhage. Methods: Thirty-one eyes of 30 consecutive patients with submacular hemorrhages undergoing vitrectomy with intravitreal tPA (50 /0.1 ml) and gas injection and completed 12 months of follow-up were evaluated. Results: The mean duration of visual symptoms was 4.1 days. Submacular blood was completely displaced in all 31 eyes after surgery. The best corrected visual acuity (logMAR) improved to 0.56 0.46 at 12 months from 1.15 0.51 at baseline (P = 0.002). The most important factors related to visual acuity at the 12-month follow-up were the underlying etiology for the submacular hemorrhage and visual acuity 3 months after surgery (P = 0.003 and P = 0.000, respectively). The 12-month visual acuity was independent of age, gender, presence of vitreous hemorrhage, sub-ILM hemorrhage, baseline visual acuity, duration of symptoms, and the diameter of the submacular hemorrhage. No retinal detachment or re-submacular hemorrhage developed during the follow-up period. Conclusions: This surgical technique can effectively displace submacular hemorrhage without complications. The 3-month visual acuity appears to predict the 12-month visual acuity. The final visual acuity was associated with the primary etiology for the submacular hemorrhage.