Therapeutic effect of subretinal injection of alteplase plus Conbercept for acute submacular hemorrhage secondary to polypoid choroidal vasculopathy

Abstract

Objective To determine the effectiveness and safety of vitrectomy plus subretinal injection of alteplase(tPA) and intravitreal injection of Conbercept for treating polypoid choroidal vasculopathy (PCV) and submacular hemorrhage (SMH). Methods This retrospective study included 32 patients (32 eyes) with large SMH and PCV who visited our hospital from January 2021 to September 2021. All patients underwent best-corrected visual acuity (BCVA), spectral domain optical coherence tomography (SD-OCT), ultra-wide angle fundus photography, fundus fluorescein angiography, and indocyanine green angiography before surgery. They were also treated by the same fundus surgeon with subretinal injection of t-PA combined with intravitreal injection of Conbercept. BCVA, ultra-wide angle fundus photography, and SD-OCT were repeated 1, 3, 6, and 12 months. The BCVA, the macular hemorrhage, macular fovea thickness (CMT) and postoperative complications were observed. Results The 32 patients (32 eyes) in this study included 20 males and 18 right eyes. The bleeding size was 6.82 ± 1.53 DD, the preoperative BCVA was 1.73 ± 0.44 logMAR and the preoperative CMT was 727.96 ± 236.40µm. Relative to the preoperative, the postoperative BCVA significantly improved at 1, 3, 6, and 12 months (P < 0.001). The final BCVA and the symptom duration were negatively correlated. Thirty patients (93.75%) had complete clearance of the SMH within 1 week postoperatively. The CMT significantly decreased postoperatively (P < 0.001). The frequency of anti-VEGF was 1–8 times (average, 4.2 ± 1.8). No patient has experienced recurrent hemorrhage or other complications. Conclusion Subretinal injection of t-PA combined with Conbercept can significantly improve the vision of patients with large acute submacular hemorrhage secondary to PCV.