First Author: R.Yamakawa JAPAN
Co Author(s): Y. Umeno K. Ishibashi Y. Matsuo M. Haruta
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To evaluate the prognostic factors for visual outcome in patients with massive subretinal haemorrhage (SRH) and/or vitreous haemorrhage (VH) associated with polypoidal choroidal vasculopathy (PCV).
Incidence of PCV has been reported to be high in Asian patients with neovascular age-related macular degeneration (AMD). In PCV, massive haemorrhage including SRH and/or VH sometimes occurs and results in severe visual loss. Patients with PCV at Kurume University Hospital were investigated.
This study was approved by the Institutional Review Board of Kurume University. Forty-three eyes of 41 patients (30 men and 11 women) with SRH and/or VH arising from PCV were enrolled in this study from January 2010 to February 2016 at Kurume University Hospital. Mean age was 70.1±10.1 years, and mean follow-up period was 34.7±22.1 months. All cases were followed up for at least 6 months. We evaluated the prognostic factors: treatment history for PCV, previous intraocular surgery, hypertension, antithrombotic therapy, SRH involving the fovea, submacular haemorrhage ≥20 disc areas, VH at the initial visit, VH during follow-up period, intravitreal injection of SF6 gas, and vitrectomy.
Final visual acuity was 0.1 or better in 24 eyes (55.8%) and less than 0.1 in 19 eyes (44.2%). When the change of 0.2 or more in LogMAR visual acuity was defined as significant change, visual acuity improved in 15 eyes (34.9%), remained unchanged in 12 eyes (27.9%), and deteriorated in 16 eyes (37.2%). When the final visual acuity less than 0.1 was defined as a poor visual outcome, the presence of submacular haemorrhage (≥20 disc areas) at the initial visit and the presence of VH at the initial visit or during the follow-up period were associated with a poor visual outcome (p < 0.05).
Incidence of PCV has been reported to be 54.7% in Japanese patients with AMD. Photodynamic therapy or intravitreal injection of anti-vascular endothelial growth factor has shown to be effective for the management of PCV with stable vision. However, PCV causes massive haemorrhage including SRH and/or VH, and it is different from typical AMD. Cases with submacular haemorrhage (≥20 disc areas) at the initial visit and cases with VH at the initial visit or during the follow-up period may have a poor visual outcome. We should select the optimal treatment modalities in eyes with PCV from the early stage of follow-up.