Progress Of Therapy Research For Polypoidal Choroidal Vasculopathy With Vitreous Hemorrhage As The First Manifestation

Objective:Polypoidal choroidal vasculopathy?PCV?is a group of ocular fundus diseases which were characterized by sub-retinal pigment epithelium?RPE?orange-red polypoidal lesions,usually accompanied by recurrent submacular hemorrhage?SMH?and even vitreous hemorrhage?VH?.In clinical work,we always have encountered with the patients whose first manifestation was sudden vitreous hemorrhage,and their final diagnosis is PCV after treatment.This article focuses on the analysis of the clinical characteristics,treatment methods and prognosis about this kind of patients.Methods:Retrospective reviewed all patients of vitreous hemorrhage caused by polypoidal choroidal vasculopathy who have underwent pars plana vitrectomy in our hospital from 2008 to 2018.After taking auxiliary examination or intraoperative diagnosis,we excluded patients of other ocular diseases or whose medical records incompletely.The data we collected were age,sex,history of general disease,time of vitreous hemorrhage,area of submacular hemorrhage,operational manner,best-corrected visual acuity,fundus findings on 3 months postoperatively and complication.Data Analysis with SPSS 23.0 Statistical Software.T test is used for continuous variable data and Fisher's exact test is used for qualitative variable data,and P<0.05 as a significant difference standard.Results:38 eyes of 38 patients were selected,23 males?23/38,60.5%?and 15 females?15/38,39.5%?,the average age was 66.50±7.43 years old.13 cases?13/38,34.2%?had hypertension,4 cases?4/38,10.5%?had diabetes,2 cases?2/38,5.3%?had coronary heart diseases before onset.Ranibizumab was injected intravitreally into 5eyes?4 preoperative,1 inoperative?.Photodynamic therapy was taken into 1 eye in the postoperative period.All patients had painless visual acuity decline with shadow occlusion.On admission,the time of PCV-related vitreous hemorrhage is from 1day to 150 days?the average duration was 50.87±36.85 days?and the area of submacular hemorrhage is from 2PD to 32PD?the mean area was10.13±7.75PD?.The preoperative BCVA was 0?non-LP?in 4 eyes,1.1 to 1.95 in 28 eyes,2 to 2.9 in 4eyes,3 in 1 eye,4.3 in 1 eye,and the mean BCVA of all patients was 1.33±0.86.The final mean BCVA was 2.33±1.03 on the postoperative third days and 3.48±0.83 in the postoperative third months.The BCVA was tested by paired sample t test.The difference was significant?P<0.001?.23-Gauge vitrectomy with internal drainage therapy was taken in 12 eyes,whose preoperative average BCVA was 0.70±0.52.In the course of final postoperative,the mean BCVA was 1.47±0.67 on the third day and2.81±0.84 in the third month.The visual acuity was improved significantly after taking operation.There was statistical significance?P<0.001?.23-Gauge vitrectomy without internal drainage therapy was taken in 26 eyes,whose preoperative average BCVA was1.62±0.84.In the course of final postoperative,the mean BCVA was 2.73±0.92 on the third day and 3.79±0.63 in the third month.The visual acuity was improved significantly after taking operation.There was statistical significance?P<0.001?.There was no difference in improvement of BCVA between the internal drainage group and the non-internal drainage group after operation(independent sample t test,P_3d=0.52,P_3mo=0.35,>0.05).Postoperative 3 months BCVA more than3.0 could be found in 29 cases?29/38,76.3%?,including 5 cases in internal drainage group.The duration of vitreous hemorrhage and the area of submacular hemorrhage had no significant effect on the prognosis of visual acuity?Fisher's exact test,PVH=1.00>0.05,PSMH=0.167>0.05?.1 patient who had active PCV lesions was found after one month of follow-up and then taking the treatment with PDT.Early postoperative complications included transient high intro ocular pression?IOP?,hyphema and hemorrhagic choroidal detachment.6 cases occurred in the internal drainage group and 1 case in the non-drainage group,with single or simultaneous occurrence.After taking symptomatic treatment,the high IOP has been controlled effectively,the hyphema in anterior chamber and superior choroidal cavity has been absorbed greatly.Conclusion:Patients with PCV-associated vitreous hemorrhage were usually complicated with submacular hemorrhage which subretinal massive hemorrhage was the risk factor.The visual prognosis of these cases was variable after pars plana vitrectomy,subretinal hemorrhage involving macular or macular scar often suggested a poor prognosis.Pas plana vitrectomy combined with silicone oil filling with subretinal internal drainage or non-internal drainage could improve the prognosis and visual acuity of the PCV patients,and there was no difference about effection in the short-term postoperative follow-up between the two groups.