Choroidal vascular hyperpermeability and submacular haemorrhage in polypoidal choroidal vasculopathy: a multi-field
Yining Zhang1, Jiaxin Pu1, Xuenan Zhuang1,2
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
Insights
Choroidal vascular hyperpermeability (CVH) is inversely linked to submacular haemorrhage (SMH) in polypoidal choroidal vasculopathy (PCV). Increased CVH may act as a protective mechanism, reducing the risk of SMH occurrence.
Area of Science:
- Ophthalmology
- Vascular Biology
- Retinal Diseases
Background:
- Polypoidal choroidal vasculopathy (PCV) is a common cause of wet age-related macular degeneration.
- Submacular haemorrhage (SMH) is a severe complication of PCV, often leading to significant vision loss.
- Choroidal vascular hyperpermeability (CVH) is a characteristic feature of PCV, but its role in SMH development is unclear.
Purpose of the Study:
- To investigate the association between choroidal vascular hyperpermeability (CVH) and the occurrence of submacular haemorrhage (SMH) in patients with polypoidal choroidal vasculopathy (PCV).
Main Methods:
- Retrospective, cross-sectional study of 189 eyes from 159 treatment-naïve PCV patients.
- Eyes categorized into haemorrhage (n=84) and non-haemorrhage (n=105) groups.
- Nine-field indocyanine green angiography (ICGA) used to assess CVH presence, number, distribution, and area; logistic regression and correlation analysis performed.
Main Results:
- The haemorrhage group had significantly lower CVH prevalence (32.1% vs 68.6%) and median count (0 vs 1) compared to the non-haemorrhage group (p<0.001).
- Both CVH presence (p<0.001) and higher counts (p=0.004) were independently associated with a reduced likelihood of SMH.
- A weak inverse correlation existed between total CVH area and haemorrhage area (Spearman's r=-0.248).
Conclusions:
- CVH presence and counts are inversely associated with SMH occurrence in PCV.
- CVH may function as a 'pressure-relief window,' mitigating elevated choroidal vascular pressure that can lead to vessel rupture and SMH.
Purpose:
To investigate the association between choroidal vascular hyperpermeability (CVH) and the occurrence of submacular haemorrhage (SMH) in polypoidal choroidal vasculopathy (PCV).
Methods:
This retrospective, cross-sectional study included 189 eyes of 159 patients with treatment-naïve PCV. Eyes were categorised into haemorrhage (n=84) and non-haemorrhage (n=105) groups based on the extent of subretinal or subretinal pigment epithelium haemorrhage. Nine-field indocyanine green angiography (ICGA) was performed to evaluate the presence, number, topographic distribution and area of CVH. Logistic regression and correlation analysis were performed to identify factors associated with SMH.
Results:
The cohort comprised predominantly male patients (67.3%), with a mean age of 65.4±7.6 years. The haemorrhage group showed significantly lower CVH prevalence (32.1% vs 68.6%; p<0.001) and median CVH count (0 vs 1; p<0.001) compared with the non-haemorrhage group. Multivariate model demonstrated that both the presence (p<0.001) and higher count (p=0.004) of CVH were independently associated with a reduced likelihood of SMH. Topographically, this negative association was most pronounced for CVH located in the posterior pole, central nasal and central superior quadrants (all p<0.05). A weak but significant inverse correlation was also observed between the total area of CVH and the area of haemorrhage (Spearman's r=-0.248).
Conclusions:
The presence and counts of CVH are inversely associated with the occurrence of SMH in PCV, suggesting CVH may serve as a 'pressure-relief window' to dissipate suddenly elevated choroidal vascular pressure which predisposes to vessel rupture.
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