bevacizumab + ranibizumab + tissue plasminogen activator

This is a combination therapy consisting of bevacizumab, ranibizumab, and tissue plasminogen activator (tPA), typically used as an intravitreal or subretinal injection for the management of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD) or polypoidal choroidal vasculopathy. - **Bevacizumab** and **ranibizumab** are monoclonal antibodies that inhibit vascular endothelial growth factor A (VEGF-A), thereby reducing abnormal blood vessel growth and leakage in the retina. - **Tissue plasminogen activator** is a recombinant protein that catalyzes the conversion of plasminogen to plasmin, promoting fibrinolysis and facilitating clot dissolution within the submacular space. The combination aims to displace or resolve SMH by dissolving blood clots with tPA while simultaneously suppressing ongoing neovascularization with anti-VEGF agents. This approach has been shown in clinical studies to improve visual acuity outcomes compared to monotherapy in patients with large or thick SMH[1][4][7].