目的：探究25G微创玻璃体切割联合41G超微视网膜下注射t-PA治疗视网膜下出血的临床研究。方法：选取2022年6月~2024年9月就诊于粤北人民医院眼科并被确诊的为黄斑下出血（SMH）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（25G玻璃体切割联合41G视网膜下注射t-PA）30眼。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)、黄斑部视网膜下出血复发率以及术后并发症发生情况。结果：治疗后7d后，观察组黄斑部下积血完全清除率较对照组更高（P＜0.05）；术后1d、6个月两组BCVA对比均无显著差异（P＞0.05），术后7d、术后1个月、3个月对比，观察组BCVA低于对照组（P＜0.05）；术后1d、术后7d、术后1个月两组眼压对比，观察组眼压均低于对照组（P＜0.05），术后3个月、6个月两组眼压对比均无显著差异（P＞0.05）；术后1d、6个月两组CRT对比均无显著差异（P＞0.05），术后7d、术后1个月、3个月对比，观察组CRT低于对照组（P＜0.05）。治疗1周后出现1例玻璃体积血，经口服药物及制动处理后2周积血吸收，视力改善。整个治疗及随访期间未发生视网膜裂孔、脱离等严重并发症，治疗结束时均未出现玻璃体积血或出血性视网膜脱离范围扩大。随访6个月未发现积血复发，所有患眼视网膜下出血均完全吸收，未见视网膜层间积液。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。

Objective: To investigate the clinical study of 25G minimally invasive vitrectomy combined with 41G ultramicroretinal injection of t-PA for the treatment of subretinal hemorrhage. Methods: 60 patients with SMH diagnosed at the Eye Hospital of Tianjin Medical University from January 2022 to September 2024 were selected and 60 eyes were divided into 30 eyes in the control group (25G vitrectomy combined with vitreous cavity injection of t-PA) and 30 eyes in the observation group (25G vitrectomy combined with 41G subretinal injection of t-PA) according to the different treatment modalities. The complete clearance rate of macular blood accumulation, best corrected visual acuity (BCVA), IOP changes, central retinal thickness (CRT), recurrence rate of macular subretinal hemorrhage, and the occurrence of postoperative complications were observed in the two groups. Results: After 7d post-treatment, the complete clearance rate of macular blood accumulation was higher in the observation group than in the control group (P<0.05); there was no significant difference in the comparison of BCVA between the two groups at 1d and 6 months postoperatively (P>0.05), and the comparison of BCVA in the observation group was lower than that of the control group at 7d postoperatively, 1 month postoperatively, and 3 months postoperatively (P<0.05); the comparison of IOP between the two groups at 1d postoperatively, 7d postoperatively, and 1 month postoperatively. IOP of the observation group was lower than that of the control group (P<0.05), and there was no significant difference in the comparison of IOP of the two groups at 3 and 6 months postoperatively (P>0.05); there was no significant difference in the comparison of CRT of the two groups at 1d and 6 months postoperatively (P>0.05), and the CRT of the observation group was lower than that of the control group in the comparison of the two groups at 7d postoperatively, 1 month postoperatively and 3 months postoperatively (P<0.05). One case of vitreous hemorrhage appeared after 1 week of treatment, and the hemorrhage was absorbed and vision improved after 2 weeks of oral medication and braking. No serious complications such as retinal tears or detachment occurred during the entire treatment and follow-up period, and no vitreous hemorrhage or hemorrhagic retinal detachment expanded at the end of treatment. No recurrence of blood accumulation was found at 6 months of follow-up, and subretinal hemorrhage was completely absorbed in all the affected eyes, with no retinal interlayer fluid accumulation. Conclusion: 25G minimally invasive vitrectomy combined with 41G ultra-subretinal 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.