THE INCIDENCE, CHARACTERISTICS, MANAGEMENT, PROGNOSIS, AND CLASSIFICATION OF BREAKTHROUGH VITREOUS HEMORRHAGE
Xin-Yu Zhao1,2, Ming-Yue Luo1,2, Li-Hui Meng1,2
1Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Insights
Breakthrough vitreous hemorrhage is a complication of polypoidal choroidal vasculopathy (PCV). Pars plana vitrectomy improves vision, but outcomes differ between pachychoroid and nonpachychoroid PCV subtypes.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Vascular Eye Conditions
Background:
- Polypoidal choroidal vasculopathy (PCV) is a significant cause of vision loss.
- Breakthrough vitreous hemorrhage is a severe complication of PCV, necessitating detailed study.
Purpose of the Study:
- To characterize breakthrough vitreous hemorrhage in patients with PCV.
- To compare outcomes and features of breakthrough vitreous hemorrhage in pachychoroid PCV versus nonpachychoroid PCV.
Main Methods:
- Retrospective review of 722 PCV patients from January 2005 to March 2020.
- Analysis of 103 eyes with breakthrough vitreous hemorrhage, including subgroup analysis of pachychoroid and nonpachychoroid PCV.
Main Results:
- Breakthrough vitreous hemorrhage occurred in 12.4% of PCV eyes.
- Pars plana vitrectomy improved visual acuity; factors like hemorrhagic retinal detachment influenced final outcomes.
- Pachychoroid PCV presented differently (younger patients, hemorrhagic PED, thicker choroid) with more complex surgeries compared to nonpachychoroid PCV.
Conclusions:
- Breakthrough vitreous hemorrhage is a challenging PCV complication requiring intervention.
- Pars plana vitrectomy and further treatments improve prognosis.
- Pachychoroid and nonpachychoroid PCV-related vitreous hemorrhage exhibit distinct clinical characteristics and prognoses.
Purpose:
To describe breakthrough vitreous hemorrhage secondary to polypoidal choroidal vasculopathy (PCV).
Methods:
Patients with the diagnosis of PCV from January 2005 to March 2020 at Peking Union Medical College Hospital were retrospectively reviewed, cases with breakthrough vitreous hemorrhage were analyzed. Subgroup analysis was conducted regarding pachychoroid PCV and nonpachychoroid PCV.
Results:
Among 722 PCV patients (834 eyes), 103 eyes with breakthrough vitreous hemorrhage (12.4%) were included. Pars plana vitrectomy and proper further interventions could significantly improve the best-corrected visual acuity from logMAR 2.15 ± 0.48 (Snellen 20/2825) to 1.65 ± 0.67 (20/893). Hemorrhagic retinal detachment, baseline central macular thickness, and best-corrected visual acuity were factors associated with final best-corrected visual acuity (P < 0.05). In the pachychoroid PCV group, patients were younger, all had hemorrhagic pigment epithelial detachment, with a higher prevalence of choroidal vascular hyperpermeability and hemorrhagic retinal detachment, thicker subfoveal choroidal thickness, and thinner central macular thickness; besides, the initial pars plana vitrectomy were more complicated, more additional surgeries had to be performed. More eyes in the nonpachychoroid PCV group had received anti-vascular endothelial growth factor or photodynamic therapy, mostly fibrovascular pigment epithelial detachment, the best-corrected visual acuity and the status of the fellow eye were significantly worse. For the final ocular status, more eyes in nonpachychoroid PCV group were taking anti-vascular endothelial growth factor monotherapy, whereas more eyes in pachychoroid PCV group were stable. The choroidal parameters of these two groups were all significantly different.
Conclusion:
Breakthrough vitreous hemorrhage is a troublesome complication of PCV. Pars plana vitrectomy and additional interventions are required for better prognosis. Vitreous hemorrhage secondary to pachychoroid PCV or nonpachychoroid PCV have different characteristics and prognosis.
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