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COMPLICATIONS OF SMH SURGERY
The reported incidence of surgical complications includes vitreous hemorrhage (8%20%)［15, 20, 33, 35, 38］, retinal detachment (3%25%)［14, 20, 28, 38］, endophthalmitis (7%)［33］, and epiretinal membrane (9%)［14］. In SST report, 16% of the operated eyes developed rhegmatogenous retinal detachment during the 12month followup, while only 2% in the observation group had rhegmatogenous retinal detachment within 36month followup［29］.
Many factors may contribute to the poor outcome of patients with SMH, which include irreversible photoreceptor damage, RPE atrophy, CNV and scar. Other related factors affecting the outcome of SMH include preoperative VA, duration and extent of SMH, severity of AMD, and followup period. Efficiency of intraocular tPA is still of considerable diversity. VA improvement ranges from 21% to 93% of the tPAcases reported. There was study showing that tPA can not penetrate through retina［42］.
The relation between SMH and CNV is uncertain. It has been reported that CNV presented in 18%68% of the cases with SMH, and CNV was found in 1/3 of the eyes with recurrence of SMH［43］.
In view of the riskbenefit ratio and the outcome of SMH, it seems that surgical management of SMH is not strongly emphasized. In current clinical practice, surgery for SMH is usually not the first choice. Doctors should not solely rely on surgical intervention in the management of SMH[44].
Evidencebased study is needed in future to validate the effect of intravitreal tPA and its theoretical basis. New therapeutic methods and their roles, such as antiVEGF therapy and microinvasive surgery also warrant further studies[45].
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