Poor long-term fellow-eye outcomes after vitrectomy with subretinal tissue plasminogen activator for AMD-related submacular hemorrhage

Abstract Purpose To evaluate the long-term prognosis of the fellow-eye in patients with age-related macular degeneration (AMD) who underwent pars plana vitrectomy (PPV) with submacular tissue plasminogen activator injection (SM-tPA) for significant submacular hemorrhage. Methods Retrospective single-center cohort study including all consecutive patients who underwent PPV with SM-tPA for AMD-related submacular hemorrhage (SMH) between 2010 and 2022, with a minimum follow-up of 2 years. Data was collected from electronic medical records and included demographic characteristics, visual acuity, optical coherence tomography findings, adverse events, further ocular diagnoses in the fellow-eye. Results Forty-seven patients (57% male; mean age 80 years) were included, with a mean follow-up of 82 months. At baseline, most patients had AMD in the fellow-eye (62% dry-AMD; 30% wet-AMD). During follow-up, AMD progressed in 64% of the patients who did not have wet-AMD in their fellow eye at the time of presentation. Seven patients (15%) experienced SMH in the fellow-eye within 1 month to 5 years after initial surgery. The mean VA of the fellow-eye at presentation was 0.64 LogMAR, with a nonsignificant improvement in the first two years. Subsequently, a statistically significant VA deterioration was observed (final mean VA 0.8 LogMAR, p =0.009). By the final follow-up, 30% of patients had better VA in the operated eye, and 26% were legally blind in the fellow-eye. Conclusion Patients treated with SM-tPA are at high risk for AMD progression and vision loss in the fellow-eye. Close monitoring of the fellow eye is warranted, and treatment decisions for the involved eye should not be based solely on good fellow-eye vision, given the long-term risk of deterioration.