Abstract General Information

Título / Title

LOW INTEGRITY RETINAL ATTACHMENT FOLLOWING SUBRETINAL TPA INJECTION: A CASE SERIES

Introdução / Purpose

To report a case series of 3 patients with subretinal hemorrhages secondary to age-related macular degeneration (AMD), all treated with pars plana vitrectomy (PPV) combined with subretinal tPA injection, drainage, and gas tamponade, and to highlight the occurrence of Low Integrity Retinal Attachment (LIRA) as a potential postoperative phenomenon.

Material e Método / Methods

This retrospective study included three elderly patients with submacular hemorrhages caused by AMD complications who underwent surgery for hemorrhage displacement. BCVA, imaging findings, and postoperative outcomes were analyzed. Autofluorescence fundus imaging and OCT were used to evaluate retinal positioning and structural integrity.

Resultados / Results

Case 1: An 84-year-old female with wet AMD in OD achieved an initial postoperative BCVA of 20/40, which stabilized at 20/30p for several years. Case 2: An 87-year-old male with AMD and type 1 CNV in OS showed BCVA improvement from 20/80 to 20/40. The postoperative period was complicated by malignant glaucoma, which resolved without residual sequelae. Case 3: An 87-year-old patient with polypoidal choroidal vasculopathy in OD improved from 20/200 to 20/50 postoperatively and reached 20/20, but still presented subjective complaints of reduced visual quality despite the anatomical and apparent functional success. Imaging demonstrated LIRA features with inferior retinal displacement in all cases.

Discussão e Conclusões / Conclusion

To the best knowledge of the authors, no cases of LIRA have been described following subretinal tPA injection. LIRA, typically associated with retinal detachment repair, was observed in all three cases after subretinal tPA injection and drainage for submacular hemorrhage. The consistent inferior displacement may be influenced by postoperative head positioning and gas tamponade forces. Retinal surgeons should consider LIRA as a possible complication in similar procedures and a potential cause for complaints in patients who achieved anatomical success.

Palavras Chave

Low Integrity Retinal Attachment; Subretinal Hemorrhage; Retinal Displacement; Subretinal tPA.