Twelve-month outcomes of subretinal tenecteplase-assisted vitrectomy for large submacular hemorrhage secondary to polypoidal choroidal vasculopathy: a retrospective consecutive case series
- 1Jinan University , ,
- 2Chongqing Nanping Aier Eye Hospital , ,
Abstract
Background: To evaluate the safety, anatomical and visual outcomes, and prognostic factors of pars plana vitrectomy (PPV) with subretinal tenecteplase (TNK-tPA) injection and gas tamponade for submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV).
Methods: In this retrospective case series, 10 eyes of 10 consecutive patients with PCV and fovea-involving SMH (>5 disc areas) underwent 25-gauge PPV, subretinal TNK-tPA injection (50 μg/0.05 mL at a single site in 7 eyes; multi-site injection totaling up to 100 μg in 3 eyes), and tamponade with 0.4 mL of pure C₃F₈ gas, followed by pro re nata anti-vascular endothelial growth factor (anti-VEGF) therapy. Best-corrected visual acuity (BCVA), central macular thickness (CMT), pigment epithelial detachment (PED), anti-VEGF treatment burden, and complications were evaluated over 12 months.
Results: Complete subfoveal hemorrhage displacement was achieved in all eyes (100%) by postoperative day 1. At 12 months, median BCVA improved from 1.25 (IQR, 1.10–1.70) to 0.30 (IQR, 0.23–0.95) logMAR (Z = −2.617, P = 0.010), and mean CMT decreased from 1,006.0 ± 183.0 μm to 205.9 ± 48.2 μm (t = 12.44, P < 0.001). PED resolved in 90.0% of eligible eyes by month 2, with a mean of 1.8 anti-VEGF injections. The 12-month BCVA correlated with time to surgery (r = 0.84, P = 0.002) and hemorrhage area (r = 0.87, P = 0.001); given the strong collinearity between these variables (r = 0.918) and the small sample size, these associations are exploratory and hypothesis-generating. No TNK-tPA–related adverse events were observed.
Conclusions: PPV with subretinal TNK-tPA injection and gas tamponade was associated with rapid hemorrhage displacement, visual improvement, and an observed mean of 1.8 anti-VEGF injections over 12 months in this small PCV cohort. Better visual outcomes were associated with shorter time to surgery and smaller hemorrhage area; these associations are exploratory given the observational design and the strong collinearity between these two factors. Larger controlled studies are needed to confirm safety and comparative effectiveness.
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BibTeX
@article{ai2026twelvemonth,
title = {{Twelve-month outcomes of subretinal tenecteplase-assisted vitrectomy for large submacular hemorrhage secondary to polypoidal choroidal vasculopathy: a retrospective consecutive case series}},
author = {Ling Ai and Xindan Meng and Shan He and Shiman Yuan and Yixia Zhang and Yi Wang},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1981363},
url = {https://europepmc.org/article/PMC/PMC13727473},
note = {CC BY},
}
RIS
TY - JOUR
TI - Twelve-month outcomes of subretinal tenecteplase-assisted vitrectomy for large submacular hemorrhage secondary to polypoidal choroidal vasculopathy: a retrospective consecutive case series
AU - Ling Ai
AU - Xindan Meng
AU - Shan He
AU - Shiman Yuan
AU - Yixia Zhang
AU - Yi Wang
PY - 2026
DA - 2026/10/20
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1981363
UR - https://europepmc.org/article/PMC/PMC13727473
AB - Background: To evaluate the safety, anatomical and visual outcomes, and prognostic factors of pars plana vitrectomy (PPV) with subretinal tenecteplase (TNK-tPA) injection and gas tamponade for submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV). Methods: In this retrospective case series, 10 eyes of 10 consecutive patients with PCV and fovea-involving SMH (>5 disc areas) underwent 25-gauge PPV, subretinal TNK-tPA injection (50 μg/0.05 mL at a single site in 7 eyes; multi-site injection totaling up to 100 μg in 3 eyes), and tamponade with 0.4 mL of pure C₃F₈ gas, followed by pro re nata anti-vascular endothelial growth factor (anti-VEGF) therapy. Best-corrected visual acuity (BCVA), central macular thickness (CMT), pigment epithelial detachment (PED), anti-VEGF treatment burden, and complications were evaluated over 12 months. Results: Complete subfoveal hemorrhage displacement was achieved in all eyes (100%) by postoperative day 1. At 12 months, median BCVA improved from 1.25 (IQR, 1.10–1.70) to 0.30 (IQR, 0.23–0.95) logMAR (Z = −2.617, P = 0.010), and mean CMT decreased from 1,006.0 ± 183.0 μm to 205.9 ± 48.2 μm (t = 12.44, P < 0.001). PED resolved in 90.0% of eligible eyes by month 2, with a mean of 1.8 anti-VEGF injections. The 12-month BCVA correlated with time to surgery (r = 0.84, P = 0.002) and hemorrhage area (r = 0.87, P = 0.001); given the strong collinearity between these variables (r = 0.918) and the small sample size, these associations are exploratory and hypothesis-generating. No TNK-tPA–related adverse events were observed. Conclusions: PPV with subretinal TNK-tPA injection and gas tamponade was associated with rapid hemorrhage displacement, visual improvement, and an observed mean of 1.8 anti-VEGF injections over 12 months in this small PCV cohort. Better visual outcomes were associated with shorter time to surgery and smaller hemorrhage area; these associations are exploratory given the observational design and the strong collinearity between these two factors. Larger controlled studies are needed to confirm safety and comparative effectiveness.
SN - 2296-858X
ER -