Subretinal Tissue Plasminogen Activator Injection Using a Nanovitreoretinal Device for Massive Submacular Hemorrhage: A Retrospective Case Series.

PURPOSE: To evaluate the efficacy of subretinal tissue plasminogen activator (tPA) injection in patients with massive submacular hemorrhage (SMH) with or without vitrectomy.

METHODS

This retrospective study included patients with massive SMH treated with subretinal tPA injection (12.5 μg/0.1 mL) using a nanovitreoretinal (NVR) device at a single tertiary referral center between 2020 and 2024. Primary outcomes were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT); secondary outcomes included SMH thickness reduction and between-group comparison of surgical approaches.

RESULTS

Eighteen eyes of 15 patients were analyzed; 11 eyes (61.1%) were from female patients. Twelve eyes underwent vitrectomy (66.7%), while six were treated without vitrectomy (33.3%). Baseline demographic and clinical characteristics were summarized descriptively because of the small and imbalanced subgroup sizes. Neovascular age-related macular degeneration was the leading etiology (17 eyes, 94.4%), comprising typical neovascular age-related macular degeneration (9 eyes, 50.0%), polypoidal choroidal vasculopathy (7 eyes, 38.9%), and retinal angiomatous proliferation (1 eye, 5.6%); the remaining eye (5.6%) had peripheral exudative hemorrhagic chorioretinopathy. BCVA improved significantly from 1.79 ± 0.77 to 1.28 ± 0.83 logMAR (p = 0.010), with 10 eyes (55.6%) achieving ≥3-line improvement. CMT decreased significantly at 6 months (673.8 ± 346.7 to 266.0 ± 327.1 μm, p = 0.019), and 81.3% of eyes achieved ≥20% CMT reduction. SMH thickness decreased significantly postinjection (536.9 ± 345.0 to 221.4 ± 443.4 μm, p = 0.020). No significant differences in final BCVA (1.24 ± 0.77 logMAR vs. 1.37 ± 1.01 logMAR, p = 0.850) or CMT reduction rate (81.8% vs. 80.0%; p > 0.999) were observed between vitrectomy and nonvitrectomy groups.

CONCLUSIONS

Subretinal tPA injection via the NVR device was associated with improvements in visual and anatomical outcomes in massive SMH. The nonvitrectomy approach showed no significant difference in outcomes compared with vitrectomy-assisted injection, but this exploratory finding should be interpreted cautiously given the small sample size.