Prognostic Factors of Vitreous Hemorrhage Secondary to Exudative Age-Related Macular Degeneration

• Published in: American journal of ophthalmology Vol. 149; no. 2; pp. 322 - 329.e1
• Main Authors: Hasegawa, Tomoko, Otani, Atsushi, Sasahara, Manabu, Gotoh, Norimoto, Ooto, Sotaro, Tamura, Hiroshi, Yamashiro, Kenji, Tsujikawa, Akitaka, Yoshimura, Nagahisa
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2010; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Diabetic retinopathy; Exudates and Transudates; Female; Fluorescein Angiography; Follow-Up Studies; Hemorrhage; Hospitals; Humans; Hypertension; Lens Implantation, Intraocular; Macular degeneration; Macular Degeneration - complications; Macular Degeneration - drug therapy; Macular Degeneration - physiopathology; Male; Medical imaging; Medical sciences; Middle Aged; Miscellaneous; Multivariate analysis; Myopia; Ophthalmology; Phacoemulsification; Photochemotherapy; Photodynamic therapy; Prognosis; Retinopathies; Retrospective Studies; Statistical analysis; Sulfur Hexafluoride - administration & dosage; Tomography, Optical Coherence; Visual Acuity - physiology; Vitrectomy; Vitreous Hemorrhage - etiology; Vitreous Hemorrhage - physiopathology; Vitreous Hemorrhage - surgery; California; Eye disease; Secondary; Retinopathy; Prognosis; Vitreous body; Age related macular degeneration; Ophthalmology; Hemorrhage
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2009.09.012

Purpose Vitreous hemorrhage (VH) is a rare but serious complication of the eyes with exudative age-related macular degeneration (AMD). This retrospective study was designed to evaluate various clinical factors that may affect the visual prognosis of patients with VH secondary to exudative AMD. Design Retrospective case study. Methods We intensively documented 31 cases of VH secondary to exudative AMD and retrospectively analyzed best-corrected visual acuity (BCVA). All eyes underwent standard pars plana vitrectomy (PPV) for treating VH. Three subgroups were created according to the clinical course and treatment history before the occurrence of VH: (1) gas group (7 eyes), pneumatic displacement with sulfur hexafluoride gas performed to treat massive submacular hemorrhage; (2) photodynamic therapy (PDT) group (9 eyes), PDT performed to treat exudative AMD; (3) untreated group (15 eyes), no treatment performed. Results As a whole, BCVA before the occurrence of VH was 1.05 ± 0.59 (logarithm of the minimal angle of resolution). After the occurrence of VH, BCVA before PPV dropped to 2.61 ± 0.82. After the operation, final BCVA improved significantly to 1.25 ± 0.73 ( P < 10−8 ). In a subgroup analysis, no statistically significant difference was seen among the 3 subgroups at any time point. We found that the eyes whose fellow eye had exudative AMD showed significantly poor final BCVA compared with the unilateral cases (0.92 ± 0.57 and 1.49 ± 0.72; P = .02). Conclusions PPV can improve visual acuity in the eyes with VH secondary to AMD, although effectiveness is limited. Medical practitioners should be cautious of the visual prognosis, especially in the cases in which the fellow eye has exudative AMD.