Hyperpigmented spots after treatment for submacular hemorrhage secondary to polypoidal choroidal vasculopathy

To investigate the characteristics and clinical course of hyperpigmented spots after submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV).

This retrospective, observational study included 87 eyes initially treated with three anti-vascular endothelial growth factor (VEGF) injections for submacular hemorrhage secondary to PCV. Patients were divided into two groups according to the presence of multiple small, dark-gray or black, pigmented lesions after initial treatment: the hyperpigmented spots group and no-hyperpigmented spots group. Baseline characteristics and re-activation of the lesion were compared between the two groups.

The mean follow-up period was 30.6 ± 12.9 months, and 41 eyes (47.1%) were included in the hyperpigmented spots group. The hyperpigmented spots group exhibited greater extent of hemorrhage (P < 0.001) and greater central foveal thickness (P = 0.045) than did the no-hyperpigmented spots group. In the hyperpigmented spots group, re-activation of the lesion was noted in 17 eyes (41.5%) at a mean duration of 15.4 ± 12.7 months after the third anti-VEGF injection. In the no-hyperpigmented spots group, re-activation was noted in 28 eyes (60.9%) at a mean duration of 6.4 ± 4.0 months after the third injection. Kaplan–Meier analysis with log-rank test revealed a significant difference in the re-activation of the lesion between the two groups (P = 0.006).

Hyperpigmented spots were associated with a large amount of submacular hemorrhage in PCV. The low incidence of re-activation and late re-activation of the lesion in eyes with hyperpigmented spots suggest that a novel follow-up and treatment strategy is required for this condition.