VITRECTOMY WITH SUBRETINAL TENECTEPLASE AND INTRAVITREAL CONBERCEPT FOR SUBMACULAR HEMORRHAGE: A Prospective Interventional Study.

Abstract

To introduce a vitrectomy technique for the submacular hemorrhage (SMH) combined with subretinal tenecteplase injection, intravitreal conbercept administration, perfluoropropane gas tamponade, and to evaluate its efficacy and safety. In this single-center, prospective, interventional study, patients underwent 25-gauge vitrectomy with subretinal tenecteplase and intravitreal conbercept injection, followed by 0.5 to 1.0 mL of pure perfluoropropane gas tamponade. The best-corrected visual acuity and central retinal thickness were assessed at baseline, and 1 month, 3 months, and 6 months postoperatively. Favorable outcome was defined as a best-corrected visual acuity ≤0.5 logarithm of the minimum angle of resolution at 6 months. Twenty eyes of 20 patients with treatment-naïve spontaneous SMH (≤30 days) secondary to polypoidal choroidal vasculopathy (70%) or retinal arterial macroaneurysms (30%) were included. Mean central retinal thickness significantly decreased from 887.1 ± 52.2 µ m to 276.7 ± 83.8 µ m ( P < 0.001) at 6 months. Notably, 75% of the treated eyes (13 out of 20) achieved a favorable outcome (best-corrected visual acuity ≤0.5 logarithm of the minimum angle of resolution; Snellen equivalent ≈ 20/63). Pearson correlation analysis revealed that the SMH onset-vitrectomy interval was significantly negatively correlated with a favorable outcome (r = -0.452, P = 0.045). After adjusting for potential interaction effect, the SMH onset-vitrectomy interval remained a statistically significant predictor of worse logarithm of the minimum angle of resolution best-corrected visual acuity (odds ratio = 1.023, 95% confidence interval, 1.013-1.034, P < 0.001). The present technique for treatment-naïve spontaneous SMH, in combination with subretinal tenecteplase injection, intravitreal conbercept administration, and perfluoropropane gas tamponade, demonstrated potential for visual improvement in eyes treated within 30 days of SMH onset.