Vitrectomy with Subretinal Tenecteplase and Intravitreal Conbercept for Submacular Hemorrhage: A Prospective Interventional Study

Purpose: To introduce a vitrectomy technique for the submacular hemorrhage (SMH) combined with subretinal tenecteplase (TNK-tPA) injection, intravitreal conbercept administration, perfluoropropane (C3F8) gas tamponade, and to evaluate its efficacy and safety. Methods: In this single-center, prospective, interventional study, patients underwent 25-gauge vitrectomy with subretinal TNK-tPA and intravitreal conbercept injection, followed by 0.5-1.0 mL of pure C3F8 gas tamponade. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed at baseline, and 1, 3, and 6 months post-operatively. Favorable outcome was defined as a BCVA ≤0.5 logarithm of the minimum angle of resolution (log MAR) at 6 months Results: Twenty eyes of 20 patients with treatment-naïve spontaneous SMH (≤30 days) secondary to polypoidal choroidal vasculopathy (70%) or retinal arterial macroaneurysms (30%) were included. Mean CRT significantly decreased from 887.1±52.2μm to 276.7±83.8μm (P < 0.001) at 6 months. Notably, 75% of the treated eyes (13 out of 20) achieved a favorable outcome (BCVA ≤0.5 log MAR; Snellen equivalent ≈20/63). Pearson’s correlation analysis revealed that the SMH onset-vitrectomy interval (SOVI) was significantly negatively correlated with a favorable outcome (r = -0.452, P = 0.045). After adjusting for potential interaction effect, the SOVI remained a statistically significant predictor of worse log MAR BCVA (odds ratio [OR] = 1.023, 95% confidence interval [CI] 1.013-1.034, P < 0.001). Conclusions: The present technique for treatment-naïve spontaneous SMH, in combination with subretinal TNK-tPA injection, intravitreal conbercept administration, and C3F8 gas tamponade, demonstrated potential for visual improvement in eyes treated within 30 days of SMH onset.