Twelve-month outcomes of subretinal tenecteplase-assisted vitrectomy for large submacular hemorrhage secondary to polypoidal choroidal vasculopathy: a retrospective consecutive case series
Year: 2026
Type: article
Abstract: Background To evaluate the safety, anatomical and visual outcomes, and prognostic factors of pars plana vitrectomy (PPV) with subretinal tenecteplase (TNK-tPA) injection and gas tamponade for submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV). Methods In this retrospective case series, 10 eyes of 10 consecutive patients with PCV and fovea-involving SMH (>5 disc areas) underwent 25-gauge PPV, subretinal TNK-tPA injection (50 μg/0.05 mL at a single site in 7 eyes; multi-site injection totaling up to 100 μg in 3 eyes), and tamponade with 0.4 mL of pure C₃F₈ gas, followed by pro re nata anti-vascular endothelial growth factor (anti-VEGF) therapy. Best-corrected visual acuity (BCVA), central macular thickness (CMT), pigment epithelial detachment (PED), anti-VEGF treatment burden, and complications were evaluated over 12 months. Results Complete subfoveal hemorrhage displacement was achieved in all eyes (100%) by postoperative day 1. At 12 months, median BCVA improved from 1.25 (IQR, 1.10–1.70) to 0.30 (IQR, 0.23–0.95) logMAR ( Z = −2.617, P = 0.010), and mean CMT decreased from 1,006.0 ± 183.0 μm to 205.9 ± 48.2 μm ( t = 12.44, P < 0.001). PED resolved in 90.0% of eligible eyes by month 2, with a mean of 1.8 anti-VEGF injections. The 12-month BCVA correlated with time to surgery ( r = 0.84, P = 0.002) and hemorrhage area ( r = 0.87, P = 0.001); given the strong collinearity between these variables ( r = 0.918) and the small sample size, these associations are exploratory and hypothesis-generating. No TNK-tPA–related adverse events were observed. Conclusions PPV with subretinal TNK-tPA injection and gas tamponade was associated with rapid hemorrhage displacement, visual improvement, and an observed mean of 1.8 anti-VEGF injections over 12 months in this small PCV cohort. Better visual outcomes were associated with shorter time to surgery and smaller hemorrhage area; these associations are exploratory given the observational design and the strong collinearity between these two factors. Larger controlled studies are needed to confirm safety and comparative effectiveness.
Source: Frontiers in Medicine
Language: English
Topic: Retinal and Macular Surgery
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223053184