Postoperative Rhegmatogenous Retinal Detachment Following Vitrectomy and Subretinal Tissue Plasminogen Activator for Submacular Hemorrhage

Abstract

Purpose : To investigate the outcomes of rhegmatogenous retinal detachment (RRD) occurring after pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) for submacular hemorrhage (SMH).

Methods : A single center, retrospective chart review of patients who underwent PPV/subretinal tPA for SMH between April 2014 and September 2023 was performed. Patients with <3 months follow-up were excluded. In cases where bilateral surgery was performed, only one eye was randomly selected for inclusion. The visual and anatomic outcomes of eyes that developed RRD following PPV/subretinal tPA were collected.

Results : Out of 167 eyes that underwent PPV/subretinal tPA for SMH, 15 (9%) eyes developed RRD, with macular involvement in 12 (80%) and proliferative vitreoretinopathy (PVR) in 9 eyes (60%). The mean follow-up for all patients was 43.9 months, and the median follow-up time for RRD cases was 32 months. The median (interquartile range, IQR) time from PPV/subretinal tPA until RRD diagnosis was 41 (22-81) days. Of these cases, 12 were treated with PPV, 1 with scleral buckle, while 2 were observed due to poor visual prognosis. Single-surgery anatomic success was achieved in 14 eyes (93.3%) at three months after the first RRD repair and 11 eyes (73.3%) at the final visit. The final anatomic success rate for reattachment was 86.7% (13 eyes) with 7 (46.7%) remaining silicone oil (SO)-filled. Retinal reattachment without SO at the final visit was achieved in 6 eyes (40%). Three eyes (20%) developed recurrent RRD and underwent additional repair during the follow-up period. The median (IQR) logarithm of the minimal angle of resolution (logMAR) [Snellen] visual acuity (VA) at the preoperative visit following SMH was 2 (2-2.3) [20/2000] and increased to 2.3 (2.2-2.7) [20/3991] at the time of RRD diagnosis (P=0.01). The median (IQR) logMAR VA [Snellen] at the final visit was 2.3 (2-2.7) [20/3991] with no significant change compared to VA at the date of RRD diagnosis (P=0.15).

Conclusions : Postoperative RRD occurred in 9% of eyes after PPV/subretinal tPA for SMH and was associated with a high rate of PVR and suboptimal visual outcomes.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.