Purpose: To assess the outcomes of patients with large submacular hemorrhage (SMH) due to age-related macular degeneration in this era of anti-vascular endothelial growth factor (VEGF). Methods: Retrospective analysis of 149 eyes of 149 patients receiving pars plana vitrectomy, subretinal tissue plasminogen activator, and gas injection (“surgical group”; n = 80) or anti-VEGF alone (“anti-VEGF group”; n = 69). Changes in visual acuity (VA), number of anti-VEGF injections, and percentage of patients with ≥3 line VA gains are compared between groups. Results: Patients in the surgical group had larger SMH than those in the anti-VEGF group, 30.35 versus 14.57 mm2 ( P < .0001). Both groups experienced similar visual gains (−0.35 logarithm of the minimal angle of resolution [logMAR] vs −0.23 in logMAR, surgical vs anti-VEGF group; P = .36). The percentage of patients gaining ≥3 lines of VA was 55% in the surgical group and 54% in the anti-VEGF group. The surgical group achieved best-recorded VA sooner (3.7 compared to 4.6 months; P = .04) and required fewer injections (3.4 injections vs 4.7 in the anti-VEGF group; P = .001). Conclusion: Surgical intervention was favored for larger hemorrhages of shorter duration. Despite extensive hemorrhage and poor baseline VA, both groups showed similar rate of significant VA improvement.
Intravitreal injection of tissue plasminogen activator as treatment for an occluded pars plana glaucoma tube