To evaluate the outcome of pars plana vitrectomy, subretinal tissue plasminogen activator (t-PA) infusion (25 μg) OR subretinal clot evacuation with a forceps. An intraocular gas tamponade with and without postsurgical antivascular endothelial growth factor (VEGF) injection for submacular hemorrage was applied per and post operatively. The procedure was followed by having the patient remain in the prone position during five days.


Retrospective, comparative, interventional case series.


We included 54 eyes of 54 patients with thick submacular hemorrhage (neovascular AMD or not) who underwent surgical displacement of the hemorrhage with or without postoperative anti-VEGF injections. Main outcome measures included degree of blood displacement, best and final postoperative visual acuity (VA), and adverse events.


All patients were followed for a minimum of 3 months. In 44 (82%) of 54 eyes, the procedure resulted in complete hemorrhage displacement from the fovea. Mean preoperative VA was 20/2255. The acuity significantly improved at month 1 and at month 3 (P < 0.001). Best postoperative visual acuity improved by at least 1 line in 44 (82%) of 54 eyes, and 17 % of eyes gained 3 lines or more at month 3. The visual acuity of the group of eyes that received postoperative anti-VEGF injection (n = 41) showed greater visual acuity improvement 6 months postoperatively compared to the group of eyes that did not receive postoperative anti-VEGF. Postoperative complications included vitreous hemorrhage in 2 eyes, 1 serous retinal detachment in 1 eye, and recurrent thick subretinal hemorrhage in 3 eyes.


Vitrectomy with subretinal t-PA injection or subretinal clot evacuation with a forceps and gas tamponade were found to be relatively effective for displacement of thick submacular hemorrhage with a significant improvement in visual acuity. However, there is a loss of acuity over time due to neovascular AMD evolution. The addition of anti-VEGF therapy may help to maintain visual acuity gains post operatively.

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