Meta-analysis compares intravitreal vs subretinal tPA for submacular hemorrhage

This meta-analysis evaluated the efficacy and safety of intravitreal injection (IVI) versus subretinal injection (SRI) of tissue plasminogen activator for the treatment of submacular hemorrhage. The analysis included 353 eyes from multiple studies. The primary outcome was final best-corrected visual acuity (BCVA), and secondary outcomes included central retinal thickness (CRT), complete displacement of hemorrhage, and adverse events.

At 1 month, BCVA was similar between the IVI and SRI groups. At 3 months, BCVA was better in the IVI group. However, at 6 months, BCVA was again similar between the two groups. Final CRT was similar between groups. The risk ratio of complete displacement of hemorrhage showed no statistical differences between the two groups.

Safety outcomes, including total adverse events, recurrent submacular hemorrhage, increased intraocular pressure, postoperative retinal detachment, and vitreous hemorrhages, showed no statistical differences between the IVI and SRI groups. Serious adverse events, discontinuations, and tolerability were not reported.

The authors did not explicitly list limitations, but the meta-analysis nature implies potential heterogeneity across included studies. Funding and conflicts of interest were not reported. Clinicians should interpret these findings cautiously, as the advantage at 3 months was not sustained at 6 months, and no significant differences in key outcomes were observed.