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. 2022 Dec 22;12(1):22139.
doi: 10.1038/s41598-022-26289-6.

Displacement of submacular hemorrhage secondary to age-related macular degeneration with subretinal injection of air and tissue plasminogen activator

Maasa Ogata  1 , Hideyasu Oh  2 , Ai Nakata  1 , Ayaka Doi  3 , Hiroki Nakayama  4 , Mariko Hasegawa  1 , Miou Hirose  1
Affiliations

Displacement of submacular hemorrhage secondary to age-related macular degeneration with subretinal injection of air and tissue plasminogen activator

Maasa Ogata et al. Sci Rep. .

Abstract

Submacular hemorrhage (SMH) can lead to devastating visual loss in patients with age-related macular degeneration. We retrospectively evaluated the surgical outcomes of vitrectomy with subretinal injection of tissue plasminogen activator, bevacizumab, and air in 13 cases. Visual prognosis, anatomical results obtained with optical coherence tomography (OCT), and their correlations were investigated. We analyzed OCT parameters including SMH height, pigment epithelial detachment (PED) height and width, and status of ellipsoid zone (EZ) line. Complete displacement of SMH was achieved in 12 eyes. At 3 months post-surgery, best-corrected visual acuity (BCVA) and SMH height exhibited significant improvements (P < 0.01). In eyes with preoperative SMH height < 300 µm and a detectable EZ line, BCVA was significantly improved at as early as 1 month, whereas the remaining eyes exhibited visual improvements only at 3 months. Postoperative BCVA positively correlated with preoperative BCVA (r = 0.86, P < 0.005), and negatively correlated with SMH size (r = 0.69, P < 0.01) and PED height (r = 0.58, P < 0.05) and width (r = 0.67, P < 0.05). Multivariate analyses confirmed preoperative BCVA as the predominant factor associated with postoperative BCVA (β = 1.093, P < 0.05). In conclusion, significant improvements in BCVA and anatomical findings can be achieved with our reported surgical technique. Preoperative OCT findings may influence the duration required for visual improvements.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Mean BCVA of all patients. *P < 0.01.
Figure 2
Figure 2
Comparison of postoperative BCVA classified by preoperative SMH height (μm). *P < 0.05.
Figure 3
Figure 3
Comparison of postoperative BCVA classified by preoperative EZ status. *P < 0.05.
Figure 4
Figure 4
Preoperative and postoperative PED height, width (μm). *P < 0.05.
Figure 5
Figure 5
Measurement of preoperative OCT parameters. Preoperative OCT with SMH. (a) SMH height. (b) PED height. (c) PED width. (d) Presumed RPE line. (e) Ellipsoid zone (EZ).
Figure 6
Figure 6
A case of an 83-year-old woman (patient 11). Horizontal OCT images and color fundus photographs at (a) baseline, (b) 1 month, and (c) 3 months post-surgery. Preoperative BCVA was 20/250, and SMH height (double headed arrow) was 604 μm. (a) The ellipsoid zone was absent before surgery. (b) At 1 month after surgery, SMH decreased to 66 μm. (c) At 3 months after surgery, SMH was completely absorbed and BCVA improved to 20/25. The ellipsoid zone was detectable at the fovea.
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