Pneumatic Displacement with Intravitreal Plasminogen Activator (PA) versus Vitrectomy with Subretinal PA for Submacular Haemorrhage

Abstract

Introduction: To compare the efficacy of pneumatic displacement with intravitreal recombinant tissue plasminogen activator (rTPA) [Group 1] versus vitrectomy with subretinal injection of rTPA with/without anti-VEGF [Group 2] for submacular haemorrhage (SMH) in patients with neovascular age-related macular degeneration (nAMD) in two tertiary referral centres. Methods: Retrospective analysis of thirty consecutive patients presenting with SMH and treated with the aforementioned regimens in two surgical units between 2012 to 2016. Primary outcome measure was SMH displacement. Secondary outcomes included best-corrected visual acuity (BCVA) change post-operatively, SMH height, SMH area, and surgical complications. Optical coherence tomography (OCT) images and clinical data used to analyse outcomes. Results: Eleven patients included in Group 1 and 19 in Group 2. Haemorrhagic displacement was complete in 9 (82.8%) out of 11 and 18 (94.7%) out of 19 patients in Groups 1 and 2, demonstrating no difference between them (p=0.536). BCVA improved by -0.50±0.74 (p=0.045) and -0.72±0.93 (p=0.004) compared to baseline at 6 months in Groups 1 and 2, with no difference between groups (p=0.155). Subfoveal haemorrhage height reduced (Group 1:-900.57μm, p=0.007; Group 2:-607.27μm, p<0.001), without difference between groups (p=0.582). SMH area reduced significantly in Group 2 but not 1 (Group 1:-44.18μm, p=0.078; Group 2:-30.28μm, p<0.001), without difference between groups (p=0.913). Conclusion: Intravitreal treatment and vitrectomy were equally effective at subfoveal haemorrhagic displacement. BCVA gains did not differ significantly between techniques. OCT data demonstrated similar efficacy in both techniques. This data supports the use of either intravitreal or vitrectomy treatment as a first line therapy for SMH.