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 and subretinal tissue plasminogen activator for submacular hemorrhage (SMH). Methods: Charts were reviewed between April 1, 2014, and September 1, 2023, for eyes that underwent pars plana vitrectomy/subretinal tissue plasminogen activator for SMH. Results: Of 167 eyes, 15 eyes (9%) developed RRD with macular detachment in 12 eyes (80%) and proliferative vitreoretinopathy (PVR) in nine eyes (60%). The median (interquartile range, IQR) time from pars plana vitrectomy/subretinal tissue plasminogen activator until RRD diagnosis was 41 days (22–81). Thirteen eyes underwent RRD repair and two eyes were observed due to poor visual prognosis. Single-surgery anatomical success was achieved in 11 eyes (85%) at three months and nine eyes (70%) at the final visit. Four eyes (27%) developed redetachment, and three eyes underwent a median of two additional repairs. The final anatomical success rate for reattachment was 92% (12/13). The median (IQR) logarithm of the minimal angle of resolution [Snellen] visual acuity at the preoperative visit after SMH was 2 (2–2.3) [20/2,000], which worsened to 2.3 (2.2–2.7) [20/4,000] at the time of RRD diagnosis ( P = 0.01) and plateaued by the final visit to 2.3 (2–2.7) [20/4,000] ( P = 0.15). Conclusion: Postoperative RRD occurred in nearly one in 10 eyes after pars plana vitrectomy/subretinal tissue plasminogen activator for SMH and was associated with a relatively high rate of PVR.