Original Articles
Surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy

https://doi.org/10.1016/S0002-9394(99)00078-1Get rights and content

Abstract

%PURPOSE: To report the visual outcome of surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy.

METHODS: Eight eyes of eight consecutive patients with thick submacular hemorrhages associated with idiopathic polypoidal choroidal vasculopathy were treated with pars plana vitrectomy and tissue plasminogen activator–assisted removal of subretinal blood (December 1995 to September 1997) or intravitreal 100% sulfur hexafluoride gas injection without tissue plasminogen activator (October 1997 to March 1998).

RESULTS: Postoperatively, laser treatment was performed for active polypoidal lesions outside the foveal avascular zone in four eyes. A retinal pigment epithelial tear was seen outside the foveal avascular zone in three eyes, and one eye developed a retinal detachment. The best-corrected visual acuity improved (by 3 or more lines) or stabilized in seven of the eight eyes. Four eyes had a final best-corrected visual acuity of 20/40 or better, and three eyes had a final best-corrected visual acuity of 20/50 to 20/200. In one eye, the visual acuity decreased from 20/100 to 20/500 because of the development of a subfoveal neovascular membrane. The membrane was excised, and histologic examination showed fibrovascular tissue between the retina and retinal pigment epithelium (type 2 pattern).

CONCLUSIONS: Surgical intervention may be of benefit in eyes with submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy.

Section snippets

Patients and methods

Between December 1995 and March 1998, eight eyes of eight consecutive patients with idiopathic polypoidal choroidal vasculopathy received surgical management of a submacular hemorrhage. The criteria for surgical management of subretinal hemorrhage were the following: (1) thick subretinal hemorrhage involving the center of the macula, (2) no white-yellow clot (organized blood) in the macula, (3) duration of the submacular hemorrhage less than 30 days, (4) no other ocular disease affecting visual

Results

The follow-up period after surgery ranged from 6 to 25 months (mean, 12.6 months). In all five eyes that underwent removal of submacular hemorrhages, most of the subretinal blood was removed at the end of the surgery. On the other hand, in the remaining three eyes that underwent pneumatic displacement of submacular hemorrhages, most of the subretinal blood displaced from the fovea and the subretinal hemorrhage became much thinner in the macula. In four eyes, laser treatment was performed for

Discussion

The natural course of idiopathic polypoidal choroidal vasculopathy is not definitely known because no study of a large series of patients with this disease has been performed. However, the visual prognosis seems to be relatively good. Spaide and associates4 reported that 12 patients had been followed up for a mean of 4.9 years and the final mean visual acuity (20/70) was not significantly different from the initial mean visual acuity (20/60). Moorthy and associates6 also reported that, although

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    This study was supported in part by the Health Sciences Research Grants from the Ministry of Health and Welfare, Tokyo, Japan.

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