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Updated: Nov 22, 2025
Author Spotlight: Overcoming Anti-VEGF Resistance Through Advanced Vascular Morphology Assessment in Choroidal Neovascularization
Published on: August 11, 2023
Comparative analysis of polypoidal choroidal vasculopathy with and without hemorrhage treated by anti-VEGF
Masanori Iwasaki1, Kenji Kobayashi2, Shuichiro Aoki2
1Department of Ophthalmology, Sapporo City General Hospital, 1-1 Kita 11-jo Nishi 13-Chome, Chuo-ku, Sapporo, 060-8604, Japan. iwasakicom@yahoo.co.jp.
Insights
Hemorrhage in polypoidal choroidal vasculopathy (PCV) does not impact visual acuity or treatment response to anti-VEGF therapy. However, massive hemorrhages in PCV are linked to larger polyps and pigment epithelium detachment.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Vascular Biology
Background:
- Polypoidal choroidal vasculopathy (PCV) is a subtype of age-related macular degeneration.
- Hemorrhage is a common complication of PCV, potentially affecting visual outcomes.
Purpose of the Study:
- To compare visual function and treatment response in PCV with and without hemorrhage.
- To evaluate the impact of hemorrhage extent on PCV characteristics and outcomes.
Main Methods:
- Retrospective observational study of 49 treatment-naive PCV patients.
- Classification into PCV with hemorrhage (26 eyes) and without hemorrhage (23 eyes).
- Subgroup analysis of massive hemorrhage (≥4 disc areas).
Main Results:
- No significant differences in baseline characteristics or anti-VEGF treatment response between groups.
- Final best-corrected visual acuity was comparable (PCV with hemorrhage: 0.33 ± 0.51 logMAR; without: 0.28 ± 0.41 logMAR).
- Massive hemorrhagic PCV showed significantly larger polyps (314.6 ± 111.4 μm) and were associated with hemorrhagic pigment epithelium detachment.
Conclusions:
- Hemorrhage presence in PCV does not significantly alter visual acuity or treatment response to anti-VEGF monotherapy.
- Massive hemorrhage development in PCV may be associated with larger polyps and hemorrhagic PED.
- PCV management and visual outcomes are not significantly different based on hemorrhage presence.
Purpose:
Visual function and treatment response after anti-vascular endothelial growth factor monotherapy were compared between polypoidal choroidal vasculopathy (PCV) with and without hemorrhage.
Methods:
We conducted a retrospective, observational study (mean, 26 months) for 49 eyes of 49 treatment-naive patients with PCV. Patients were classified into PCV with hemorrhage (26 eyes) or without hemorrhage (23 eyes). PCV with massive hemorrhage subgroup has four or more disc-hemorrhagic areas and included five eyes.
Results:
There were no significant differences in patient age, sex, systolic blood pressure, diastolic blood pressure, presence of choroidal vascular hyperpermeability, number of polyps, maximum polyp size, lesion area, and presence of pigment epithelium detachment (PED) between the two groups. Except for the course of PCV-related hemorrhage, treatment number and its response were similar between the groups. Best-corrected visual acuity at the last visit in PCV with hemorrhage was 0.33 ± 0.51 logMAR (20/41) comparable with 0.28 ± 0.41 logMAR (20/38) without hemorrhage at the last visit (p = 0.944). Maximum polyp size in massive hemorrhagic PCV was significantly larger (314.6 ± 111.4 μm) than that of small hemorrhagic PCV (229.0 ± 119.1 μm; p = 0.037). All PCV with massive hemorrhage was accompanied by large hemorrhagic PED.
Conclusion:
There were no significant differences in the baseline characteristics, treatment intervention, or suppression of disease activity between PCV with and without hemorrhage. Final visual acuity of PCV did not differ with or without hemorrhage. Development of massive hemorrhaging in PCV may be associated with both large polyps and hemorrhagic PED.
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