Curative effect of internal and external combined surgery for intraocular hemorrhage of polypoidal choroidal vascular disease_Chinese Journal of Ocular Fundus Diseases

Authors：

Mao Ziqing , Wu Hongxi ,  You Zhipeng , Zou Yuling

Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China;

Corresponding author：

You Zhipeng, Email: 1305937632@qq.com

Keywords：

Choroid diseases/surgery; Vitreous hemorrhage; Retinal detachment; Vitrectomy; Sclera; Drainage

DOI：

10.3760/cma.j.cn511434-20190412-00145

Video：

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Objective To observe the effect of combined operation of internal and external surgery for intraocular hemorrhage of polypoidal choroidal vascular disease (PCV).Methods Retrospective clinical research. From January to August 2018, 14 eyes of 14 patients with PCV combined with vitreous hemorrhage (VH) with hemorrhagic retinal detachment confirmed by eye examination at the Second Affiliated Hospital of Nanchang University were enrolled in this study. The average disease course was 1.12±0.68 months. The visual acuity decreased from 2 to 14 days. The average time from hemorrhagic retinal detachment to surgery was 6.32±2.82 d. There were 9 eyes with BCVA of light sensing, 3 eyes of hand movement, and 2 eyes of counting fingers. The average macular foveal thickness (CFT) was 564.6±102.2 μm. The range of retinal detachment involves equal or greater than 2 quadrants. 23G vitrectomy surgery was used to remove VH, and subretinal hemorrhage was drained through external scleral drainage to reset the retina. One week and 1 and 2 months after the operation, the eyes were injected with 0.05 ml of ranibizumab in the vitreous cavity. The average follow-up time after surgery was 6.24±1.16 months. One week after the operation, 1, 3, and 6 patients were examined with the same equipment and methods before the operation to observe the condition of BCVA, CFT, intraocular pressure and retinal reattachment. Non-parametric tests were used to compare BCVA before and after surgery.Results VH was completely cleared in all eyes, and no iatrogenic retinal hole appeared during the operation. Six months after the operation, there were 1 eye with BCVA of hand movement, 1 eye of counting fingers, 8 eyes of 0.1, 2 eyes of 0.2 and 2 eyes of over than 0.2; the average CFT was 336.4±54.8 μm. Compared with before surgery, the BCVA was significantly improved (Z=－3.711, P=0.000), the CFT was significantly decreased (t=3.212, P=0.006). OCT examination showed that the macular morphology and structure were clearly visible. Of the 14 eyes, 13 eyes were reattached, 1 eye was detached again after silicone oil removal. Intraocular pressure increased in 3 eyes within 1 week after surgery, including 1 eye with a small amount of blood in the anterior chamber. No recurrent VH was found in all eyes during follow-up.Conclusions Combined internal and external surgery for PCV combined with VH with hemorrhagic retinal detachment is safe and effective.

Citation： Mao Ziqing, Wu Hongxi, You Zhipeng, Zou Yuling. Curative effect of internal and external combined surgery for intraocular hemorrhage of polypoidal choroidal vascular disease. Chinese Journal of Ocular Fundus Diseases, 2020, 36(7): 504-508. doi: 10.3760/cma.j.cn511434-20190412-00145 Copy

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2.	陶勇, 侯婧, 黎晓新. 254例息肉样脉络膜血管病变的临床特征分析[J]. 中华眼底病杂志, 2012, 28(5): 441-444. DOI: 10.3760/cma.j.issn.1005-1015.2012.05.003.Tao Y, Hou J, Li XX. Chnical characteristics of 254 cases of polypoidal chomidal vasculopathy[J]. Chin J Oeul Fundus Dis, 2012, 28(5): 441-444. DOI: 10.3760/cma.j.issn.1005-1015.2012.05.003.
3.	Cackett P, Wong D, Yeo I. A classification system for polypoidal choroidal vasculopathy[J]. Retina, 2009, 29(2): 187-191. DOI: 10.1097/IAE.0b013e318188c839.
4.	de Silva SR, Bindra MS. Early treatment of acute submacular haemorrhage secondary to wet amd using intravitreal tissue plasminogen activator, C₃F₈, and an anti-VEGF agent[J]. Eye (Lond), 2016, 30(7): 952-957. DOI: 10.1038/eye.2016.67.
5.	Ibanez HE, Williams DF, Thomas MA, et al. Surgical management of submacular hemorrhage: a series of 47 consecutive cases[J]. Arch Ophthalmol, 1995, 113(1): 62-69. DOI: 10.1001/archopht.1995.01100010064022.
6.	Kimura S, Morizane Y, Hosokawa M, et al. Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator[J]. Am J Ophthalmol, 2015, 159(4): 683-689. DOI: 10.1016/j.ajo.2014.12.020.
7.	于滨, 冉莉莉, 张晶, 等. 微创玻璃体手术联合雷珠单抗治疗息肉样脉络膜血管病变合并玻璃体出血和出血性视网膜脱离[J]. 中华实验眼科杂志, 2016, 34(8): 690-691. DOI: 10.3760/cma.j.issn.2095-0160.2016.08.004.Yu B, Ran LL, Zhang J, et al. Minimally invasive vitrectomy combined with ranibizumab in the treatment of polypoid choroidal vasculopathy with vitreous hemorrhage and hemorrhagic retinal detachment[J]. Chin J Exp Ophthalmol, 2016, 34(8): 690-691. DOI: 10.3760/cma.j.issn.2095-0160.2016.08.004.
8.	Maruko I, Iida T, Saito M, et al. Clinical characteristics of exudative age-related macular degeneration in Japanese patients[J]. Am J Ophthalmol, 2007, 144(1): 15-22. DOI: 10.1016/j.ajo.2007.03.047.
9.	Lincoff H, Madjarov B, Lincoff, N, et al. Pathogenesis of the vitreous cloud emanating from subretinal hemorrhage[J]. Arch Ophthalmol, 2003, 121(1): 91-96. DOI: 10.1001/archopht.121.1.91.
10.	Uyama M, Wada M, Nagai Y, et al. Polypoidal choroidal vasculopathy: natural history[J]. Am J Ophthalmol, 2002, 133(5): 639-648. DOI: 10.1016/s0002-9394(02)01404-6.
11.	Sandhu SS, Manvikar S, Steel DH. Displacement of submacular hemorrhage associated with age-related macular degeneration using vitrectomy and submacular tPA injection followed by intravitreal ranibizumab[J]. Clin Ophthalmol, 2010, 21(4): 637-642. DOI: 10.2147/opth.s10060.
12.	Wei Y, Zhang Z, Jiang X, et al. A surgical approach to large subretinal hemorrhage using pars plana vitrectomy and 360°retinotomy[J]. Retina, 2015, 35(8): 1631-1639. DOI: 10.1097/IAE.0000000000000501.
13.	Gomi F, Sawa M, Sakaguchi H, et al. Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy[J]. Br J Ophthalmol, 2008, 92(1): 70-73. DOI: 10.1136/bjo.2007.122283.
14.	Oishi A, Kojima H, Mandai M, et a1. Comparison of the effecc of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12 month LAPTOP study results[J]. Am J Ophthalmol, 2013, 156(4): 644-651. DOI: 10.1016/j.ajo.2013.05.024.
15.	Hikichi T. Six-year outcomes of antivascular endothelial growth factor monotherapy for polypoidal choroidal vasculopathy[J]. Br J ophthalmol, 2018, 102(1): 97-101. DOI: 10.1136/bjophthalmol-2017-310448.
16.	Yiu G, Mahmoud TH. Subretinal hemorrhage[J]. Dev Ophthalmol, 2014, 54: 213-222. DOI: 10.1159/000360469.

1. Cho JH, Ryoo NK, Cho KH, et al. Incidence rate of massive submacular hemorrhage and its risk factors in polypoidal choroidal vasculopathy[J]. Am J Ophthalmol, 2016, 169: 79-88. DOI: 10.1016/j.ajo.2016.06.014.
2. 陶勇, 侯婧, 黎晓新. 254例息肉样脉络膜血管病变的临床特征分析[J]. 中华眼底病杂志, 2012, 28(5): 441-444. DOI: 10.3760/cma.j.issn.1005-1015.2012.05.003.Tao Y, Hou J, Li XX. Chnical characteristics of 254 cases of polypoidal chomidal vasculopathy[J]. Chin J Oeul Fundus Dis, 2012, 28(5): 441-444. DOI: 10.3760/cma.j.issn.1005-1015.2012.05.003.
3. Cackett P, Wong D, Yeo I. A classification system for polypoidal choroidal vasculopathy[J]. Retina, 2009, 29(2): 187-191. DOI: 10.1097/IAE.0b013e318188c839.
4. de Silva SR, Bindra MS. Early treatment of acute submacular haemorrhage secondary to wet amd using intravitreal tissue plasminogen activator, C₃F₈, and an anti-VEGF agent[J]. Eye (Lond), 2016, 30(7): 952-957. DOI: 10.1038/eye.2016.67.
5. Ibanez HE, Williams DF, Thomas MA, et al. Surgical management of submacular hemorrhage: a series of 47 consecutive cases[J]. Arch Ophthalmol, 1995, 113(1): 62-69. DOI: 10.1001/archopht.1995.01100010064022.
6. Kimura S, Morizane Y, Hosokawa M, et al. Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator[J]. Am J Ophthalmol, 2015, 159(4): 683-689. DOI: 10.1016/j.ajo.2014.12.020.
7. 于滨, 冉莉莉, 张晶, 等. 微创玻璃体手术联合雷珠单抗治疗息肉样脉络膜血管病变合并玻璃体出血和出血性视网膜脱离[J]. 中华实验眼科杂志, 2016, 34(8): 690-691. DOI: 10.3760/cma.j.issn.2095-0160.2016.08.004.Yu B, Ran LL, Zhang J, et al. Minimally invasive vitrectomy combined with ranibizumab in the treatment of polypoid choroidal vasculopathy with vitreous hemorrhage and hemorrhagic retinal detachment[J]. Chin J Exp Ophthalmol, 2016, 34(8): 690-691. DOI: 10.3760/cma.j.issn.2095-0160.2016.08.004.
8. Maruko I, Iida T, Saito M, et al. Clinical characteristics of exudative age-related macular degeneration in Japanese patients[J]. Am J Ophthalmol, 2007, 144(1): 15-22. DOI: 10.1016/j.ajo.2007.03.047.
9. Lincoff H, Madjarov B, Lincoff, N, et al. Pathogenesis of the vitreous cloud emanating from subretinal hemorrhage[J]. Arch Ophthalmol, 2003, 121(1): 91-96. DOI: 10.1001/archopht.121.1.91.
10. Uyama M, Wada M, Nagai Y, et al. Polypoidal choroidal vasculopathy: natural history[J]. Am J Ophthalmol, 2002, 133(5): 639-648. DOI: 10.1016/s0002-9394(02)01404-6.
11. Sandhu SS, Manvikar S, Steel DH. Displacement of submacular hemorrhage associated with age-related macular degeneration using vitrectomy and submacular tPA injection followed by intravitreal ranibizumab[J]. Clin Ophthalmol, 2010, 21(4): 637-642. DOI: 10.2147/opth.s10060.
12. Wei Y, Zhang Z, Jiang X, et al. A surgical approach to large subretinal hemorrhage using pars plana vitrectomy and 360°retinotomy[J]. Retina, 2015, 35(8): 1631-1639. DOI: 10.1097/IAE.0000000000000501.
13. Gomi F, Sawa M, Sakaguchi H, et al. Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy[J]. Br J Ophthalmol, 2008, 92(1): 70-73. DOI: 10.1136/bjo.2007.122283.
14. Oishi A, Kojima H, Mandai M, et a1. Comparison of the effecc of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12 month LAPTOP study results[J]. Am J Ophthalmol, 2013, 156(4): 644-651. DOI: 10.1016/j.ajo.2013.05.024.
15. Hikichi T. Six-year outcomes of antivascular endothelial growth factor monotherapy for polypoidal choroidal vasculopathy[J]. Br J ophthalmol, 2018, 102(1): 97-101. DOI: 10.1136/bjophthalmol-2017-310448.
16. Yiu G, Mahmoud TH. Subretinal hemorrhage[J]. Dev Ophthalmol, 2014, 54: 213-222. DOI: 10.1159/000360469.

Chinese Journal of Ocular Fundus Diseases

Curative effect of internal and external combined surgery for intraocular hemorrhage of polypoidal choroidal vascular disease

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