Li Y.a· Wang X.b· Chen H.a· Lin W.a· Chen X.b· Luo X.b· Wei Y.a

Author affiliations

aNational Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
bFundus Disease Center, Xiamen Eye Center Affiliated to Xiamen University, Xiamen, China

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply

Start free trial

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: July 15, 2021
Accepted: December 23, 2022
Published online: January 10, 2023

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 3

ISSN: 0030-3755 (Print)
eISSN: 1423-0267 (Online)

For additional information: https://www.karger.com/OPH

Abstract

Introduction: The aim of this study was to evaluate the therapeutic effect of a new drainage procedure for treating subretinal hemorrhage (SRH) in hemorrhagic retinal detachment (RD) in patients with polypoidal choroidal vasculopathy (PCV). Methods: Forty-three eyes with hemorrhagic RD attributable to PCV underwent vitrectomy. External drainage via sclerotomy was performed in 25 eyes and internal drainage via retinotomy was performed in 18 eyes, respectively. Based on different surgical techniques, the external drainage group was divided into simple external drainage subgroup (10 eyes), external drainage combined with intravitreal injections of recombinant tissue plasminogen activator (tPA) subgroup (7 eyes), and external drainage combined with subretinal and/or submacular injections of tPA subgroup (8 eyes). The internal drainage group was divided into small retinotomy subgroup (7 eyes) and large retinotomy subgroup (11 eyes). The anatomic reattachment of the retina and postoperative complications were compared between different groups and subgroups. Results: The external drainage technique had shorter mean operation time, higher retinal reattachment rate, and fewer postoperative complications rate compared to the internal drainage procedure. The subfoveal hemorrhage subsided significantly sooner in the large retinotomy subgroup and external drainage combined with subretinal and/or submacular injections of tPA subgroup compared to the small retinotomy subgroup and the external drainage without tPA group (p < 0.05). The small retinotomy subgroup had higher rates of hemorrhage and elevated IOP compared to other subgroups during the first week of the postoperative period (p < 0.05). Conclusion: Our results suggest that external drainage of SRH combined with subretinal and/or submacular injections of tPA can make the operation simpler, shorten the operation time, reduce the postoperative complications with rapid regression of subfoveal hemorrhage, resulting in an effective and safe therapeutic strategy for treating hemorrhagic RD.

© 2023 S. Karger AG, Basel

References Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, et al. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res. 2016;53:107–39. Cheung CMG, Lee WK, Koizumi H, Dansingani K, Lai TYY, Freund KB. Pachychoroid disease. Eye. 2019;33(1):14–33. Cheung CMG, Lai TYY, Ruamviboonsuk P, Chen SJ, Chen Y, Freund KB, et al. Polypoidal choroidal vasculopathy: definition, pathogenesis, diagnosis, and management. Ophthalmology. 2018;125(5):708–24. Hou J, Tao Y, Li XX, Zhao MW. Clinical characteristics of polypoidal choroidal vasculopathy in Chinese patients. Graefes Arch Clin Exp Ophthalmol. 2011;249(7):975–9. Zhao XY, Luo MY, Meng LH, Zhang WF, Li B, Wang EQ, et al. The incidence, characteristics, management, prognosis and classification of breakthrough vitreous hemorrhage secondary to polypoidal choroidal vasculopathy. Retina. 2021;41(8):1675–85. Cho SC, Cho J, Park KH, Woo SJ. Massive submacular haemorrhage in polypoidal choroidal vasculopathy versus typical neovascular age-related macular degeneration. Acta Ophthalmol. 2021;99(5):e706–14. Cho JH, Ryoo NK, Cho KH, Park SJ, Park KH, Woo SJ. Incidence rate of massive submacular hemorrhage and its risk factors in polypoidal choroidal vasculopathy. Am J Ophthalmol. 2016;169:79–88. Kim JH, Kim JW, Kim CG, Lee DW. Long-term clinical course after vitrectomy for breakthrough vitreous hemorrhage secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Sci Rep. 2020;10(1):359. Lin HC, Yang CH, Yang CM, Medscape. Medscape: visual outcomes of vitrectomy for polypoidal choroidal vasculopathy-related breakthrough vitreous haemorrhage. Eye. 2014;28(7):797–806; quiz 807. Li ZX, Hu YJ, Atik A, Lu L, Hu J. Long-term observation of vitrectomy without subretinal hemorrhage management for massive vitreous hemorrhage secondary to polypoidal choroidal vasculopathy. Int J Ophthalmol. 2019;12(12):1859–64. Liu H, Zhang LY, Li XX, Wu MQ. 23-Gauge vitrectomy with external drainage therapy as a novel procedure to displace massive submacular hemorrhage secondary to polypoidal choroidal vasculopathy. Medicine. 2016;95(32):e4192. Oshima Y, Ohji M, Tano Y. Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage. Br J Ophthalmol. 2007;91(2):193–8. Jung JH, Lee JK, Lee JE, Oum BS. Results of vitrectomy for breakthrough vitreous hemorrhage associated with age-related macular degeneration and polypoidal choroidal vasculopathy. Retina. 2010;30(6):865–73. Choi YJ, Hyun J, Choi KS, Rhee MR, Lee SJ. Bullous hemorrhagic retinal detachment because of massive subretinal hemorrhage in patients with age-related macular degeneration. Retina. 2013;33(7):1365–74. Kim TY, Kang HG, Choi EY, Koh HJ, Kim SS, Lee JH, et al. Prognostic factors and long-term surgical outcomes for exudative age-related macular degeneration with breakthrough vitreous hemorrhage. Korean J Ophthalmol. 2020;34(4):281–9. Iwase T, Baba T, Saito Y, Nizawa T, Yokouchi H, Kubota-Taniai M, et al. Surgical outcomes of vitrectomy for breakthrough vitreous hemorrhage in eyes with exudative age-related macular degeneration. Int Ophthalmol. 2021;41(5):1835–44. Brown GC, Tasman WS, Shields JA. Massive subretinal hemorrhage and anticoagulant therapy. Can J Ophthalmol. 1982;17(5):227–30. el Baba F, Jarrett WH 2nd, Harbin TS Jr, Fine SL, Michels RG, Schachat AP, et al. Massive hemorrhage complicating age-related macular degeneration. Clinicopathologic correlation and role of anticoagulants. Ophthalmology. 1986;93(12):1581–92. Tilanus MA, Vaandrager W, Cuypers MH, Verbeek AM, Hoyng CB. Relationship between anticoagulant medication and massive intraocular hemorrhage in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2000;238(6):482–5. Vander JF, Federman JL, Greven C, Slusher MM, Gabel VP. Surgical removal of massive subretinal hemorrhage associated with age-related macular degeneration. Ophthalmology. 1991;98(1):23–7. Narayanan R, Mithal K, Jalali S, Chhablani JK, Mathai A, Ali MH. Vitreous haemorrhage in massive hemorrhagic polypoidal choroidal vasculopathy: clinical characteristics and surgical outcomes: vitreous hemorrhage in PCV. Int J Retina Vitreous. 2015 Dec 20;1:25. Chu TG, Cano MR, Green RL, Liggett PE, Lean JS. Massive suprachoroidal hemorrhage with central retinal apposition: a clinical and echographic study. Arch Ophthalmol. 1991;109(11):1575–81. Obuchowska I, Mariak Z, Ustymowicz A. The role of ultrasound examinations in diagnosis of massive suprachoroidal hemorrhage occurring as a postoperative complication of intraocular surgery. Klin Oczna. 2003;105(3–4):225–31. Kimura S, Morizane Y, Hosokawa M, Shiode Y, Kawata T, Doi S, et al. Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator. Am J Ophthalmol. 2015;159(4):683–9. Fassbender JM, Sherman MP, Barr CC, Schaal S. Tissue plasminogen activator for subfoveal hemorrhage due to age-related macular degeneration: comparison of 3 treatment modalities. Retina. 2016;36(10):1860–5. Chang W, Garg SJ, Maturi R, Hsu J, Sivalingam A, Gupta SA, et al. Management of thick submacular hemorrhage with subretinal tissue plasminogen activator and pneumatic displacement for age-related macular degeneration. Am J Ophthalmol. 2014 Jun;157(6):1250–7. Stanescu-Segall D, Balta F, Jackson TL. Submacular hemorrhage in neovascular age-related macular degeneration: a synthesis of the literature. Surv Ophthalmol. 2016;61(1):18–32. Article / Publication Details

First-Page Preview

Received: July 15, 2021
Accepted: December 23, 2022
Published online: January 10, 2023

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 3

ISSN: 0030-3755 (Print)
eISSN: 1423-0267 (Online)

For additional information: https://www.karger.com/OPH

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.