目的：探究25G微创玻璃体切割联合41G超微视网膜下注射组织型纤溶酶原激活剂(t-PA)治疗黄斑区视网膜下出血(SMH)的临床疗效。

方法：回顾性研究。选取2022年6月至2024年9月就诊于粤北人民医院眼科并被确诊为黄斑区视网膜下出血的患者60例60眼，根据治疗方式不同分为对照组30眼(25G玻璃体切割联合玻璃体腔注射t-PA)和观察组30眼(25G玻璃体切割联合41G视网膜下注射t-PA)。观察两组患者的黄斑部积血完全清除率、最佳矫正视力(BCVA)、眼压变化、中央视网膜厚度(CRT)、术后并发症发生情况。

结果：两组一般资料具有可比性。治疗后7 d，观察组黄斑部积血完全清除率较对照组更高(100% vs 80%，P<0.05)。术后1 d，6 mo两组BCVA比较无显著差异(均P>0.05)，术后7 d，1、3 mo观察组BCVA优于对照组(均P<0.05)。术后1、7 d，1 mo观察组眼压低于对照组(均P<0.05)，术后3、6 mo两组眼压无差异(均P>0.05)。术后1 d，6 mo两组CRT比较无差异(均P>0.05)，术后7 d，1、3 mo观察组CRT低于对照组(均P<0.05)。观察组并发症总发生率与对照组比较无差异(0 vs 10%，P>0.05)。

结论：25G微创玻璃体切割联合41G超微视网膜下注射t-PA能更高效清除视网膜下出血，促进早期解剖结构恢复，且长期视力预后与常规方法相当，安全性良好。

METHODS: Retrospective study. A totally 60 patients(60 eyes)who visited the Ophthalmology Department of Yuebei People's Hospital from June 2022 to September 2024 and were diagnosed with submacular hemorrhage were selected. According to different treatment methods, they were divided into a control group of 30 eyes(25G vitrectomy combined with intravitreal injection of t-PA)and an observation group of 30 eyes(25G vitrectomy combined with 41G subretinal injection of t-PA). The complete clearance rate of macular hemorrhage, best corrected visual acuity(BCVA), changes in intraocular pressure, central retinal thickness(CRT), the occurrence of postoperative complications were observed in the two groups of patients.

RESULTS:The two groups of general data are comparable. After treatment for 7 d, the rate of complete clearance of macular hemorrhage was higher in the observation group than in the control group(100% vs 80%, P<0.05). There was no significant difference between the two groups in the comparison of BCVA at 1 d and 6 mo postoperatively(all P>0.05), and in the comparison of BCVA between the two groups at 7 d, 1, and 3 mo postoperatively, BCVA of the observation group was better than that of the control group(all P<0.05); and the intraocular pressure of the observation group was lower than that of the control group at 1 d, 7 d, and 1 mo postoperatively(all P<0.05), and there was no significant difference between the two groups in the comparison of intraocular pressure at 3 and 6 mo postoperatively(all P>0.05). There was no significant difference between the two groups in the comparison of CRT at 1 d and 6 mo postoperatively(all P>0.05), and CRT was lower than that of the control group at 7 d, 1 and 3 mo postoperatively(all P<0.05). The total incidence of complications in the observation group was not statistically different from that in the control group(0 vs 10%, P>0.05).

CONCLUSION: The 25G minimally invasive vitrectomy combined with 41G ultra-microsubretinal injection of t-PA is more efficient in removing subretinal hemorrhage, promotes early anatomical restoration, and has a comparable long-term visual prognosis to the conventional method, with a favorable safety profile.