ObjectiveFovea-involving subretinal haemorrhage is challenging to manage with uncertain visual outcomes. We reviewed outcomes of patients with fovea-involving macular haemorrhage treated with pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) with pneumatic displacement.Methods and AnalysisThis is a retrospective interventional case series. All patients with submacular haemorrhage who underwent PPV with subretinal tPA injection were included. Reasons for exclusion encompassed patients who underwent intravitreal tPA injection in the office without surgery, insufficient follow-up or documentation. Primary outcomes of interest were postoperative visual acuity (VA) at month 1 and 3. Secondary outcomes were median VA at month 3 by location of haemorrhage and underlying diagnosis.ResultsThirty-seven total patients were included. The mean age was 68.2 years, with 54.1% (20/37) females. The most common aetiology was exudative macular degeneration (43.2%), followed by undifferentiated choroidal neovascularisation (CNV) (18.9%), polypoidal choroidal vasculopathy (18.9%), traumatic CNV (10.8%), macroaneurysm (5.4%) and proliferative diabetic retinopathy (2.7%). Median preoperative VA was 20/2000, postoperative month 1 was 20/347 (p<0.01), improving to 20/152 (p<0.01) at month 3. Proportion of patients gaining vision 3+ lines in vision was 15/36 (42%). Mean preoperative central subfield thickness on optical coherence tomography was 512.2 µm for sub-retinal pigment epithelium haemorrhage and 648.2 µm for subretinal haemorrhage (p=0.48). Difference in VA by diagnosis was not significant (p=0.60).ConclusionsPPV with subretinal tPA injection and pneumatic displacement of submacular haemorrhage offers modest visual recovery for a diverse group of patients. Location of haemorrhage or specific diagnosis may not predict outcome.
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Purpose
To report the visual acuity (VA) outcomes after pars plana vitrectomy (PPV) for delayed vitreoretinal sequelae of infectious endophthalmitis. All eyes were initially treated with intravitreal antibiotics (Abx).
Methods
Multicenter, retrospective, consecutive case series.
Results
Forty-two eyes met study criteria. The mean follow-up was 48 weeks (SD±61.8). Mean interval from Abx to PPV was 13 weeks (SD±14.3, range 2-70). Indications for PPV included vitreous opacity (VO) (n=22), epiretinal membrane (ERM) (n=9), and retinal detachment (RD) (n=11). LogMAR VA improved from 1.87 (Snellen equivalent: 20/1482) preoperatively to 1.35 (Snellen equivalent: 20/447) at final evaluation (p<0.001). logMAR VA improved significantly for patients with vitreous opacities (P<0.01) and retinal detachment (P=0.02) but not for patients with epiretinal membranes (P=0.08).
Conclusions
Patients with infectious endophthalmitis can gain vision if they have a PPV for delayed sequelae such as vitreous opacities or for retinal detachment.
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