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

Purpose: To investigate the incidence and outcomes of rhegmatogenous retinal detachment (RRD) occurring after pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) for submacular hemorrhage (SMH). Methods: Charts were reviewed between April 1, 2014 and September 1, 2023 for eyes that underwent PPV/subretinal tPA for SMH. Results: Out of 167 eyes, 15 (9%) eyes developed RRD with macular detachment in 12 (80%) and proliferative vitreoretinopathy (PVR) in 9 eyes (60%). The median (interquartile range, IQR) time from PPV/subretinal tPA until RRD diagnosis was 41 (22-81) days. Single-surgery anatomic success was achieved in 11 eyes (85%) at three months and 9 eyes (70%) at the final visit. Four eyes (27%) developed redetachment and three underwent a median of two additional repairs. The final anatomic success rate for reattachment was 92% (12/13). The median (IQR) logMAR [Snellen] visual acuity at the preoperative visit following SMH was 2 (2-2.3) [20/2000], which worsened to 2.3 (2.2-2.7) [20/4000] at the time of RRD diagnosis (P=0.01) and plateaued by the final visit to 2.3 (2-2.7) [20/4000] (P=0.15). Conclusion: Postoperative RRD occurred in nearly 1 in 10 eyes after PPV/subretinal tPA for SMH and was associated with a relatively high rate of PVR.