Comparative analysis of anatomy and fibrosis formation between vitrectomy and vitrectomy combined with intravitreal rt-PA injection into the subretinal macular space for submacular haemorrhage

Abstract Background/Objectives: To compare the effects of vitrectomy alone and vitrectomy combined with subretinal injection of recombinant tissue plasminogen activator (rt-PA) for submacular haemorrhage(SMH).Subjects/Methods: In this retrospective study, 52 patients were diagnosed with SMH, of whom 43 were identified as having polypoidal choroidal vasculopathy (PCV). 19 patients underwent vitrectomy with intravitreal rt-PA injection into the submacular space, and 33 underwent only vitrectomy. Best visual acuity was recorded preoperatively, as well as at 1 week, 1 month, and 3 months postoperatively. Using the Heidelberg optical coherence tomography (OCT) follow-up model, the areas and heights of pigment epithelial detachment (PED), areas of retinal fluid (RF), and central macular thickness (CMT) were measured. Retinal fibrosis within the vascular arcade was evaluated using Optos during follow-up.Results One week postoperatively, the combined group started showing a significant decrease in the PED area, height, CMT and RF, with notable improvements in visual acuity at 1 month, whereas in the vitrectomy-only group, PED area significantly decreased after 1 week, along with a significant reduction in the visual acuity in the first month, but a subsequent increase in the third month. CMT only showed significantly reduction at 1week. In the combined group, two patients developed scars within the vascular arcade in the posterior pole during follow-up, whereas in the vitrectomy-only group, this occurred in 13 patients.Conclusion Vitrectomy with rt-PA injection into the submacular space demonstrates effectiveness and safety for treating SMH, as well as good prevention of scarring.