Effect of Subretinal Injection of Tissue-type Plasminogen Activator for the Treatment of Submacular Hemorrhage Complicating Polypoidal Choroidal Vasculopathy

Overview

Journal Zhong Nan Da Xue Xue Bao Yi Xue Ban

Specialty General Medicine

Date 2025 Feb 11

PMID 39931773

Authors

Guoli Zheng

Nan Wang

Wenbo Lei

Yao Xu

Xiaobo Xia

Siqi Xiong

Affiliations

Soon will be listed here.

Abstract

Objectives: Polypoidal choroidal vasculopathy (PCV) is a major cause of vision loss among older adults worldwide and is particularly common in Asians. When the aneurysmal dilatation of blood vessels or the rupture of widened small veins/arteries occurs, it leads to submacular hemorrhage (SMH), which can result in irreversible damage to vision over time. This study aims to evaluate the surgical outcomes and complications of pars plana vitrectomy (PPV) combined with intraoperative subretinal injection of tissue-type plasminogen activator (t-PA) and postoperative intravitreal injection of anti-vascular endothelial growth factor (VEGF) for the treatment of SMH secondary to PCV.

Methods: Thirteen patients (13 eyes) with SMH secondary to PCV treated at the Eye Center, Xiangya Hospital, Central South University, from September 2020 to December 2021, were included in this study. All patients underwent PPV combined with subretinal injection of t-PA during surgery and received postoperative intravitreal injections of anti-VEGF. Best corrected visual acuity (BCVA), intraocular pressure, absorption of subretinal hemorrhage, progression of the primary lesion, surgical complications, and factors associated with postoperative efficacy were analyzed preoperatively, 1 week postoperatively, 1 month postoperatively, and 6 months postoperatively.

Results: All patients completed the 6-month follow-up, and at the final visit, 100% of the subretinal hemorrhage of 13 patients was completely cleared. BCVA significantly improved at both 1 month and 6 months postoperatively compared to preoperative and 1-week postoperative levels (all <0.05). Patients over 60 years old and those with lesions located beneath the fovea had statistically significant differences in visual recovery compared to younger patients and those with extrafoveal lesions (=0.045 and =0.006, respectively). No significant correlation was found between disease duration, extent of hemorrhage, presence or absence of preoperative vitreous hemorrhage (VH), and visual recovery at 6 months postoperatively (all >0.05). Ten patients had an intact ellipsoid zone, and 5 patients had an intact retinal pigment epithelium layer, however, the difference in preoperative and postoperative visual acuity between those with and without intact microstructures was not statistically significant (all >0.05). At the final follow-up, 2 patients had retinal neuroepithelial edema, and 1 patient had retinal pigment epithelium layer detachment. Postoperative complications included 1 patient of macular hole and 1 patient of retinal pigment epithelium layer tear.

Conclusions: PPV combined with subretinal t-PA injection and postoperative intravitreal anti-VEGF injection effectively clears SMH secondary to PVC with few surgical complications and significantly improves visual function of the patients over 6-month long-term follow-up.

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