Three-dimensional heads-up system assisted pars plana vitrectomy and subretinal recombinant tissue plasminogen activator injection for submacular hemorrhage

Xinyu Zhao; Qing Zhao; Erqian Wang; Ningning Li; Lihui Meng; Wenfei Zhang; Tan Wang; Youxin Chen; Hanyi Min

doi:10.1186/s40662-023-00326-5

Three-dimensional heads-up system assisted pars plana vitrectomy and subretinal recombinant tissue plasminogen activator injection for submacular hemorrhage

Eye Vis (Lond). 2023 Mar 1;10(1):8. doi: 10.1186/s40662-023-00326-5.

Authors

Xinyu Zhao^#^{1

2}, Qing Zhao^#^{1

2}, Erqian Wang^#^{1

2}, Ningning Li³, Lihui Meng^{1

2}, Wenfei Zhang^{1

2}, Tan Wang^{1

2}, Youxin Chen^{4

5}, Hanyi Min^{6

7}

Affiliations

¹ Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
² Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
³ Department of Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
⁴ Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China. chenyx@pumch.cn.
⁵ Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. chenyx@pumch.cn.
⁶ Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China. minhy@pumch.cn.
⁷ Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. minhy@pumch.cn.

^# Contributed equally.

Abstract

Background: To evaluate the outcomes of three-dimensional (3D) heads-up system assisted pars plana vitrectomy (PPV) and subretinal injection of recombinant tissue plasminogen activator (rt-PA) for submacular hemorrhage (SMH).

Methods: Medical records of SMH patients who underwent 3D heads-up system assisted-PPV and subretinal injection of rt-PA from June 2021 to January 2022 were reviewed. The main outcomes included best-corrected visual acuity (BCVA), SMH absorption, and perioperative complications.

Results: We finally included 18 SMH eyes, most of which happened secondary to polypoidal choroidal vasculopathy (PCV) (10, 55.56%), followed by retinal arterial microaneurysm (RAM) (5, 27.78%), traumatic retinopathy (2, 11.11%) and neovascular age-related macular degeneration (nAMD) (1, 5.56%). The greatest linear dimension (GLD) and height of SMH were 6538.17 ± 2533.11 μm and 937.36 ± 420.21 μm, respectively. After an average postoperative follow-up period of 131.06 ± 38.96 days, patients' BCVA improved significantly from 1.85 ± 0.62 to 1.14 ± 0.82 logMAR (P < 0.05). SMH was completely and partially absorbed in 9 (50.00%) and 6 (33.33%) eyes, with no occurrence of iatrogenic retinal break. However, 4 additional PPVs were performed to manage the postoperative SMH and/or vitreous hemorrhage (VH) recurrence (2, 11.11%) and retinal detachment (RD) occurrence (2, 11.11%). Preoperative BCVA was significantly correlated with postoperative BCVA in multiple linear regression analysis (P < 0.05), and hemorrhagic pigment epithelial detachment (PED) was significantly correlated with SMH and VH recurrence in univariate binary logistic regression analysis (P < 0.05).

Conclusions: The 3D heads-up system assisted-PPV and subretinal injection of rt-PA were efficacious in eliminating SMH and improving visual prognosis with satisfactory safety profile, while caution should be taken for PCV patients with hemorrhagic PED and massive SMH.

Keywords: Efficacy; Recombinant tissue plasminogen activator; Safety; Submacular hemorrhage; Three-dimensional heads-up system.