Visual acuity outcome in patients with subretinal hemorrhage - office procedure vs. surgical treatment

Alon Tiosano*, Orly Gal-Or, Maayan Fradkin, Rotem Elul, Assaf Dotan, Amir Hadayer, Judith Brody, Rita Ehrlich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the effects of intravitreal injection of tissue plasminogen activator (tPA) and gas vs. pars plana vitrectomy (PPV) surgery as first-line treatment for subretinal hemorrhage. Methods: Retrospective study of 107 adults treated for subretinal hemorrhage at a tertiary hospital during 2008–2019; 51 received injection of tPA and gas and 56 underwent PPV. Results: No between-group differences were found in age and sex, medical history, use of anticoagulants or antiplatelets, history of ocular surgeries, and previous use of intravitreal anti-VEGF. Overall follow-up time was longer in the PPV group (median 4.9 vs 3.28 years, p = 0.005). The hemorrhage was displaced in a similar percentage of patients in the tPA-and-gas group (n = 40, 78.4%) and the PPV group (n = 45, 80.4%) (p = 0.816). Approximately 80% of patients in the tPA-and-gas group were able to forgo PPV surgery. Visual acuity (in LogMAR) was similar in the two groups prior to the diagnosis of subretinal hemorrhage but better in the tPA-and-gas group at the end of follow-up (p < 0.001). Conclusion: Injection of gas and tPA can be done immediately following diagnosis of subretinal hemorrhage as an office procedure. Visual acuity outcome is good, with a high rate of blood displacement. About 20% of patients might require additional PPV as secondary intervention.

Original languageEnglish
Pages (from-to)506-513
Number of pages8
JournalEuropean Journal of Ophthalmology
Issue number1
StatePublished - Jan 2023


  • Intravitreal injection
  • PPV
  • office procedure
  • subretinal hemorrhage
  • tPA
  • tissue plasminogen activator


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