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Prognostic Factors and Clinical Outcomes

Plemel, David J. A., MD; Lapere, Steven R.J., MBChB; Rudnisky, Christopher J., MD, MPH; Tennant, Matthew T. S., MD

doi: 10.1097/IAE.0000000000001931
Original Study

Purpose: To study the prognostic factors and clinical outcomes of patients who underwent pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and gas tamponade for the treatment of subfoveal hemorrhage (SFH).

Methods: A retrospective noncomparative interventional case series.

Results: Seventy-eight eyes from 77 patients were included. A total of 84.6% of eyes developed SFH from age-related macular degeneration. Partial or complete displacement of the SFH was achieved in 91.5% of eyes within 2 months of surgery. Visual acuity improved from 20/1,449 preoperatively to 20/390 after a mean follow-up time of 6.3 months, corresponding to approximately 5 lines of Snellen acuity improvement (P < 0.001). Better visual acuity was associated with the absence of age-related macular degeneration (P = 0.02) and less hemorrhage superior to the fovea (P < 0.001). Final visual acuity was not associated with the area of SFH (P = 0.17), use of anticoagulants (P = 0.14), or visibility of the ellipsoid layer by optical coherence tomography (P = 0.64). Nine patients (11.5%) developed a recurrence of SFH within the follow-up period. Recurrence of SFH was not associated with concurrent anticoagulant therapy (P = 0.52).

Conclusion: An etiology other than age-related macular degeneration with less hemorrhage superior to the fovea predicts a better outcome in patients with SFH treated with pars plana vitrectomy, subretinal tissue plasminogen activator, and gas tamponade.

Vitrectomy with subretinal tissue plasminogen activator and gas is effective at improving visual acuity in eyes with large subfoveal hemorrhage. Visual acuity outcomes are best in eyes with an etiology other than age-related macular degeneration and with less hemorrhage superior to the fovea.

Department of Ophthalmology, University of Alberta, Alberta, Canada.

Reprint requests: Matthew T. S. Tennant, MD, Suite 400 10924 107 Avenue, NW Edmonton, Alberta T5H 0X5, Canada; e-mail:

Paper presented at Canadian Ophthalmological Society, Montreal, Canada, June 16, 2017.

None of the authors has any financial/conflicting interests to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

All works for this paper was performed in Edmonton, Alberta, Canada.

© 2019 by Ophthalmic Communications Society, Inc.