RHEGMATOGENOUS RETINAL DETACHMENT AFTER VITRECTOMY AND SUBRETINAL TISSUE PLASMINOGEN ACTIVATOR FOR SUBMACULAR HEMORRHAGE.

Abstract

To investigate the incidence and outcomes of rhegmatogenous retinal detachment (RRD) occurring after pars plana vitrectomy and subretinal tissue plasminogen activator for submacular hemorrhage (SMH). Charts were reviewed between April 1, 2014, and September 1, 2023, for eyes that underwent pars plana vitrectomy/subretinal tissue plasminogen activator for SMH. Of 167 eyes, 15 eyes (9%) developed RRD with macular detachment in 12 eyes (80%) and proliferative vitreoretinopathy (PVR) in nine eyes (60%). The median (interquartile range, IQR) time from pars plana vitrectomy/subretinal tissue plasminogen activator until RRD diagnosis was 41 days (22-81). Thirteen eyes underwent RRD repair and two eyes were observed due to poor visual prognosis. Single-surgery anatomical success was achieved in 11 eyes (85%) at three months and nine eyes (70%) at the final visit. Four eyes (27%) developed redetachment, and three eyes underwent a median of two additional repairs. The final anatomical success rate for reattachment was 92% (12/13). The median (IQR) logarithm of the minimal angle of resolution [Snellen] visual acuity at the preoperative visit after SMH was 2 (2-2.3) [20/2,000], which worsened to 2.3 (2.2-2.7) [20/4,000] at the time of RRD diagnosis ( P = 0.01) and plateaued by the final visit to 2.3 (2-2.7) [20/4,000] ( P = 0.15). Postoperative RRD occurred in nearly one in 10 eyes after pars plana vitrectomy/subretinal tissue plasminogen activator for SMH and was associated with a relatively high rate of PVR.