Recurrence associated with 2-year visual acuity after subretinal tissue plasminogen activator for submacular hemorrhage in neovascular age-related macular degeneration

Abstract

Purpose: To identify predictors of the 2-year best-corrected visual acuity (BCVA) after subretinal tissue plasminogen activator (tPA) injection for massive submacular hemorrhage (SMH) complicating neovascular age-related macular degeneration (nAMD). Study design: A prospective, observational study. Methods: This study included consecutive eyes with massive SMH and nAMD that underwent vitrectomy with subretinal tPA injection and follow-up for 2 years. We analyzed the correlation between the 2-year BCVA and other parameters, including baseline BCVA, SMH height, SMH size, and SMH recurrence. Results: This study analyzed 20 eyes of 20 patients (72.5 ± 7.2 years). Two years after surgery, the mean logarithm of the minimum angle of resolution (logMAR) BCVA changed from 0.72 (Snellen equivalent, 20/105) ± 0.40 at baseline to 0.80 (Snellen equivalent, 20/126) ± 0.92. The BCVA did not change significantly during the 2-year observation period (P = 0.39). Compared to baseline, the 2-year BCVA improved in 11 eyes (55%) and declined in 6 eyes (30%) by more than 0.30 logMAR, including all five eyes with recurrence. The 2-year BCVA was correlated only with recurrence (P < 0.001, β = 0.85). Conclusions: This study suggests that recurrence was a robust determinant of poor 2-year BCVA after vitrectomy with subretinal tPA injection for SMH complicating nAMD and that subretinal tPA injection was effective in most cases, without recurrence. Our findings highlight the importance of establishing methods for preventing and controlling recurrence to maintain long-term BCVA.