Pars plana vitrectomy followed by subretinal or intravitreal injection with Conbercept and tissue plasminogen activator for clearance of submacular hemorrhage secondary to idiopathic polypoidal choroidal vasculopathy.

PURPOSE: The optimal treatment approach for submacular hemorrhage (SMH) secondary to idiopathic polypoid choroidal vasculopathy (IPCV) remains uncertain. This study aimed to explore the prognosis and complications of pars plana vitrectomy (PPV) followed by subretinal or intravitreal injection with Conbercept (0.05 ml, 10 mg/ml) and tissue plasminogen activator (t-PA) (0.05 ml ~ 0.1 ml, 0.25 mg/ml) for submacular hemorrhage (SMH) secondary to IPCV.

METHODS

This retrospective study included patients with SMH secondary to IPCV who received PPV followed by subretinal or intravitreal injection with Conbercept and t-PA at the Affiliated Eye Hospital of Nanchang University between March and November 2023. The rate of SMH clearance, best corrected visual acuity (BCVA), and central macular thickness (CMT), and postoperative complications at 1 week, 1 month, 3 months and 6 months post-treatment were collected.

RESULTS

A total of 41 patients were included, with 22 (8 males, 14 left eyes) of who received subretinal injection.Patients who received subretinal injection showed significantly less times of injections (P = 0.008), compared with those received intravitreal injection. Repeated measurement analysis showed that, compared with intravitreal injection, patients who received subretinal injection exhibited significant higher SMH clearance ratio (P < 0.001), while comparable BCVA (P = 0.942) and CMT (0.906). In addition, the occurrence of postoperative complications, including vitreous hemorrhage (P = 0.999) and macular hemorrhage (P = 0.463), between those received subretinal and intravitreal injection were similar.

CONCLUSION

Compared with intravitreal injection, PPV followed by subretinal injection with Conbercept and t-PA might be a more optimal protocol with higher SMH clearance ratio for SMH Secondary to IPCV.