Ultrasonographic Characteristics and Treatment Outcomes of Surgery for Vitreous Hemorrhage in Idiopathic Polypoidal Choroidal Vasculopathy

doi:10.1016/j.ajo.2006.05.055

American Journal of Ophthalmology

Volume 142, Issue 4, October 2006, Pages 608-619.e4

https://doi.org/10.1016/j.ajo.2006.05.055 Get rights and content

Purpose

To describe the ultrasonographic characteristics and treatment outcomes of surgery in vitreous hemorrhage (VH) associated with idiopathic polypoidal choroidal vasculopathy (IPCV).

Design

Retrospective interventional and observational case series.

Methods

Clinical, ultrasound, and surgical data of 10 consecutive patients operated for VH due to IPCV in a tertiary eye institute was studied by chart review. Data were analyzed to determine the clinical features, ultrasonographic characteristics, and surgical outcomes. An additional five patients with IPCV without VH were evaluated by ultrasound in various stages of the disease.

Results

Between January 1998 and March 2005, 10 eyes of 10 patients underwent vitreous surgery for VH associated with IPCV. Characteristic ultrasonographic features that helped the diagnosis preoperatively included focal choroidal thickening without excavation or acoustic hollowing with associated low reflective echoes of dispersed VH, or diffuse choroidal thickening and low-intensity echoes of dispersed hemorrhage on either side of the retinal spike, often without vitreous detachment spike. Oral corticosteroids were provided preoperatively to patients with associated exudative retinal detachment. Indocyanine green angiography (ICGA) confirmed IPCV postoperatively. Focal lesions were treated with laser photocoagulation. Anatomical success was seen in nine of 10 eyes. Visual acuity improved in five of 10 eyes but was limited by macular pathology in other five eyes. The most common complication was iatrogenic tears. Some eyes had recurrent IPCV lesions in follow-up.

Conclusions

Characteristic ultrasonographic features could identify IPCV in eyes with VH. Anatomical and visual outcomes of our management approach were encouraging and need further study.

Section snippets

Methods

A retrospective study was performed for 10 consecutive patients (group A) operated for VH in a tertiary eye institute. The institutional review board policy did not require permission for such a study that was done for routine clinical care of patients. Para plana vitrectomy was performed from January 1998 through March 2005, after appropriate informed consent for surgery was obtained. Cause of VH was confirmed postoperatively by ICGA as to be secondary to IPCV. Patient records were analyzed

Results

The VH study cohort included three men and seven women, and the mean age was 55.9 years (range 42 to 67 years). Duration of symptoms in nine of 10 patients ranged from four to 60 days (mean 28.2 days). One patient (patient 10) was asymptomatic initially and later developed vision loss. Symptoms included floaters in two eyes and sudden painless but severe vision loss in eight eyes. Eight fellow eyes were normal. Two patients (patients 3 and 7) had macular lesions with focal and diffuse

Discussion

In the present study, we describe the ultrasonographic features of IPCV in eyes with and without VH. Two types of USG lesions were seen, possibly representing different stages of the hemorrhagic retinal elevations. First, the most important sign was presence of low-echoreflective opacities on either side of a high reflective membrane. This occurs because of dispersed hemorrhage both in the vitreous cavity and behind the retina–retinal pigment epithelium complex. Besides excluding rhegmatogenous

Sandra L. Parra, MD, received her medical degree at Universidad Industrial de Santander (U.I.S) in Bucaramanga, Colombia in 1996. She completed her Ophthalmology residency and was the chief resident at Fundacion Oftalmologica de Santander Clinica Carlos Ardila Lulle (U.I.S) and a vitreoretinal fellowship at L.V. Prasad Eye Institute in Hyderabad, India in 2003. Dr Parra works at Colombian coffee zone in Manizales at Clinica de La Presentacion, Instituto Oftalmologico de Caldas and Centro de

References (6)

H. Iijima et al.
Optical coherence tomography of idiopathic polypoidal choroidal vasculopathy
Am J Ophthalmol
(1999)
L.A. Yannuzzi et al.
Idiopathic polypoidal choroidal vasculopathy
Retina
(1990)
R.F. Spaide et al.
Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy
Retina
(1995)

There are more references available in the full text version of this article.

Cited by (14)

Systemic steroids as an aid to the management of Idiopathic Polypoidal Choroidal Vasculopathy (IPCV): A descriptive analysis
2016, Saudi Journal of Ophthalmology
Citation Excerpt :
There is a report of the use of local steroids as an adjunct to treatment for IPCV.17,18 The role of oral steroids in IPCV, however, is unclear and, to an extent controversial, mentioned in an earlier publication from our institute,12 wherein a patient with a large, tense pigment epithelial detachment was treated with steroids prior to further treatment. The underlying basis is of course that IPCV is possibly an inflammatory process and may respond to steroids.
To determine the role of systemic steroids in improving visual acuity, preventing recurrence and hastening pigment epithelial detachment resolution in IPCV patients.
Retrospective computer assisted comparative case series of consecutive patients with documented IPCV who did and did not receive systemic steroids as part of their treatment regimen between 2007 and 2012. Patients who had systemic contraindication to steroid therapy were excluded from the steroid arm. Data collected included demographics, the best corrected visual acuity, details of the ocular and systemic exam, the treatment offered, the follow-up period and the final visual and anatomic outcomes. Outcome measures included the final BCVA, the time to resolution of the associated pigment epithelial detachment (PED, if present), the recurrence rate and the associated side effects, if any. Appropriate statistical analysis was done. Statistical significance: p < 0.05.
14 patients (14 eyes) had received systemic steroids in the stated period; these were compared with 26 consecutive patients (26 eyes) who did not. Mean age: 59.24 vs 62.38 years (A vs B). Mean baseline BCVA: 1.86 ± 1.24 logMAR vs 2.12 ± 1.48 logMAR (A vs B). 8 females in Group A and 14 in Group B. 11 patients in group A and 19 in group B had associated systemic hypertension. Therapy consisted of laser photocoagulation, anti-vascular endothelial growth factor therapy, photodynamic therapy or a combination of these. Mean follow-up: 43.21 ± 11.32 months (Group A) vs 48.24 ± 9.75 months (Group B). BCVA at three months was significantly better (0.84 ± 0.74 logMAR vs 1.16 ± 0.89 (p = 0.039). Final BCVA: 0.86 ± 0.78 logMAR (Group A) vs 1.29 ± 0.92 (Group B, p = 0.042). 7 patients in group A and 12 in Group B had a recurrence (insignificant difference). 1 patient in Group A and 7 in Group B had unresolved disease (persistent PED) at the end of follow-up (OR: 4.60; 95% CI 1.7–11.10).
Steroids appear to improve visual acuity and accelerate the resolution of the PEDs in patients with IPCV and large PEDs, but do not seem to influence recurrence.
Genetic variants in pigment epithelium-derived factor influence response of polypoidal choroidal vasculopathy to photodynamic therapy
2011, Ophthalmology
Citation Excerpt :
All 3 patients with a macular hemorrhage among those who required additional treatment within 3 months after PDT had an rs12603825 AA genotype. Recurrent hemorrhage is one of the most symbolic signs of PCV,19,21 and visual outcome is poor in eyes that have a massive subretinal hemorrhage involving the macula.14,38 Furthermore, subretinal hemorrhage after PDT is a common finding in patients with PCV.39,40
To investigate whether photodynamic therapy (PDT) outcomes of polypoidal choroidal vasculopathy (PCV) are related to baseline clinical characteristics, smoking history, or genetic factors by analyzing the retreatment-free period after the first PDT.
Retrospective cohort study.
The study consisted of 167 patients with PCV who underwent PDT as their first treatment.
We targeted 638 single nucleotide polymorphisms (SNPs) in 42 possible susceptible genes for age-related macular degeneration to evaluate their relation to the effectiveness of PDT for PCV. For this evaluation, we used 2 methods: (1) survival analysis, with the retreatment-free period as the target; and (2) logistic regression test between the need for additional therapy within 3 months after the first PDT and the genotypes, with age, gender, smoking status, and greatest linear dimension (GLD) at baseline as covariates. The contributions of smoking status and GLD at baseline for the retreatment-free period also were evaluated. Contributions of these factors to visual prognosis were evaluated for 1 year after PDT.
Retreatment-free period after the first PDT for PCV. Secondary outcome measures included correlation of the susceptible factor to the retreatment requirement within the 3-month follow-up and the mean visual acuity change.
In survival analyses, SERPINF1 rs12603825 showed a significant association with the retreatment-free period after the first PDT; those patients homozygous for the minor allele A of rs12603825 received additional treatment after PDT within significantly shorter times than those with other genotypes (P = 0.0038). There was no significant difference in the retreatment-free period between baseline GLD and smoking status. Retreatment within 3 months was required significantly more in patients with the AA genotype, even after taking into consideration the effect of clinical characteristics (age, gender), baseline PCV lesion size, and smoking status (P = 0.0027). Furthermore, patients with the AA genotype showed significantly worse visual prognosis after PDT (P = 0.013).
Pigment epithelium-derived factor (SERPINF1 or PEDF) polymorphisms may influence the initial response to and visual prognosis after PDT for PCV. Our findings may lead to understanding the pathogenesis of PCV and modification of the effects of PDT.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Association of LOC387715 A69S With Vitreous Hemorrhage in Polypoidal Choroidal Vasculopathy
2008, American Journal of Ophthalmology
To investigate whether the LOC387715 polymorphism is associated with polypoidal choroidal vasculopathy (PCV) and with vitreous hemorrhage (VH), one of the most severe clinical phenotypes, in the Japanese population.
Cross-sectional case-control association study.
One hundred and nine Japanese patients with PCV, composed of nine patients associated with VH (VH group) and 100 patients without VH (non-VH group), and 85 control subjects were analyzed for the LOC387715 polymorphism (rs = 10490924), using denaturing high-performance chromatography.
There was a significant difference in the T allele frequency between PCV patients and control subjects (P < .0001). In comparison with wild-type homozygosity (GG), homozygosity for the at-risk allele genotype (TT) increased the likelihood for PCV 8.4-fold (3.6 to 19.5, 95% confidence interval [CI]) and heterozygosity for the at-risk allele genotype (TG) increased the likelihood for PCV 4.0-fold (1.9 to 8.4, 95% CI). There was a significant difference in the genotypic frequency at the LOC387715 site between the VH and non-VH groups (P = .0099, Chi-square test) with the TT genotype occurring in 88.9% in the VH group and 37.0% in the non-VH group. The frequency of the T allele in the VH group was significantly greater than that in the non-VH group (0.944 vs 0.610; P = .0039, Fisher exact test).
The LOC387715 polymorphism is associated with PCV and clinical severity in the subgroups of PCV in the Japanese population.
Effects of Anti-Vascular Endothelial Growth Factor Drugs before and after Pars Plana Vitrectomy in Patients with Polypoidal Choroidal Vasculopathy and Vitreous Hemorrhage
2021, Journal of Ocular Pharmacology and Therapeutics
Surgical outcomes of vitrectomy for breakthrough vitreous hemorrhage in eyes with exudative age-related macular degeneration
2021, International Ophthalmology
Surgery therapy for polypoidal choroidal vasculopathy
2020, Chinese Journal of Experimental Ophthalmology

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Subhadra Jalali, MS, graduated from Jammu (1986) and postgraduated (1989) from Chandigarh, India. Her fellowships include Retina Vitreous (Hyderabad, 1993), Ocular genetics, Electrophysiology and Uveitis (NEI, 1995) and Pediatric retinal disorders (William Beaumont Hospital, US 1999). As a consultant at L.V. Prasad Eye Institute (1994), Dr Jalali have done 180 presentations, 60 publications and received a few awards. Her field of interest includes pediatric vitreoretinal problems including ROP, Ocular trauma, posterior uveitis and Primary Retinal Degenerations including visual electrophysiology.

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Supported in part by Hyderabad Eye Institute, Hyderabad, India.

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Original articleUltrasonographic Characteristics and Treatment Outcomes of Surgery for Vitreous Hemorrhage in Idiopathic Polypoidal Choroidal Vasculopathy

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Ophthalmol

Idiopathic polypoidal choroidal vasculopathy

Retina

Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy

Retina

Original article
Ultrasonographic Characteristics and Treatment Outcomes of Surgery for Vitreous Hemorrhage in Idiopathic Polypoidal Choroidal Vasculopathy