Comparing postoperative outcomes of three-dimensional versus traditional microscopic vitrectomy and subretinal rt-PA injection for submacular hemorrhage

To compare the postoperative outcomes of par plana vitrectomy (PPV) with subretinal recombinant tissue plasminogen activator (rt-PA) injection for submacular hemorrhage (SMH), utilizing three-dimensional (3D) heads-up or traditional microscopic (TM) visualization systems. Patients who were diagnosed with SMH and received PPV and subretinal rt-PA injection were enrolled in the retrospective cohort study. Patients were categorized to the 3D group and the TM group according to the visualization systems used in surgery. Best corrected visual acuity (BCVA), lesion parameters and the occurrence rate of postoperative adverse events were longitudinally recorded and compared. The 3D group (n = 19) and the TM group (n = 20) exhibited comparable baseline characteristics. Polypoidal choroidal vasculopathy (64.10%) was the leading cause of SMH. At the last visit, the enhancement of BCVA from baseline was 0.41 (95%CI 0.14-0.67) LogMAR in the 3D group and 0.30 (95%CI 0-0.59) LogMAR in the TM group, respectively (P = 0.555). SMH lesion parameters, including the height, greatest linear dimension and area, along with central retinal thickness, changed similarly during follow-up. Major adverse events, including photoreceptor/retinal pigment epithelial atrophy (92.31%), epiretinal membrane (41.03%), and recurrent SMH (30.77%), also occurred similarly at each follow-up in the two groups. The two visualization systems showed comparable postoperative efficacies and safety profiles in assisting PPV and subretinal rt-PA injection for SMH treatment.