COMPARABLE RESULTS OF SUBRETINAL INJECTION AND INTRAVITREAL INJECTION OF TISSUE PLASMINOGEN ACTIVATOR IN THE TREATMENT OF SUBMACULAR HEMORRHAGE: A Meta-Analysis of Efficacy.

PURPOSE: To estimate the efficacy of intravitreal injection (IVI) versus subretinal injection (SRI) of tissue plasminogen activator in the treatment of submacular hemorrhage (SMH).

METHODS

A comprehensive literature search was conducted in six major data sets from inception to 31 October 2025. Random effects meta-analysis was performed to evaluate the final best-corrected visual acuity (BCVA, logMAR) and the changes in central retinal thickness (CRT, μm), and the risk ratio of complete displacement of hemorrhage.

RESULTS

A total of seven studies on 353 eyes were finally included. Best-corrected visual acuity was similar between the IVI and SRI groups at 1 month and 6 months postoperation, while better in the IVI group 3 months postoperatively. The final CRT was similar between the two groups. There were no statistical differences between the two groups in the RRs of complete displacement of hemorrhage, total adverse events, recurrent SMH, increased intraocular pressure, postoperative retinal detachment, and vitreous hemorrhages.

CONCLUSION

The IVI group showed a better BCVA at 3 months, the two groups showed comparable results in the recovery of BCVA, CRT, and complete hemorrhage displacement at the final visit (within 6 months).