Incidence and risk factors of massive subretinal hemorrhage in retinal angiomatous proliferation

• Published in: PloS one Vol. 12; no. 10; p. e0186272
• Main Authors: Lee, Jae Hyung, Lee, Mee Yon, Lee, Won Ki
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12-10-2017; Public Library of Science (PLoS)
• Subjects: Acuity; Age; Aged; Aged, 80 and over; Anastomosis; Angiography; Angiomatosis - complications; Angiomatosis - diagnostic imaging; Angiomatosis - pathology; Archives & records; Biology and Life Sciences; Dosage and administration; Drug dosages; Epithelium; Eye; Eye (anatomy); Family medical history; Female; Health aspects; Hemorrhage; Hospitals; Humans; Incidence; Injection; Macular degeneration; Male; Medical imaging; Medicine and Health Sciences; Middle Aged; Optical Coherence Tomography; Patients; Physical Sciences; Physiological aspects; Research and Analysis Methods; Retina; Retinal Diseases - complications; Retinal Diseases - diagnostic imaging; Retinal Diseases - pathology; Retinal Hemorrhage - diagnostic imaging; Retinal Hemorrhage - epidemiology; Retinal Hemorrhage - pathology; Retinal pigment epithelium; Review boards; Risk analysis; Risk Factors; t-Plasminogen activator; Tissue plasminogen activator; Tomography; Vascular endothelial growth factor; Visual acuity
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0186272

To evaluate the incidence and associated risk factors of massive subretinal hemorrhage (SRH) in patients with retinal angiomatous proliferation (RAP).
A total of 187 eyes of 135 treatment-naıve patients diagnosed with RAP were evaluated retrospectively. Clinical records including the time between the initial visit, last anti-vascular endothelial growth factor (VEGF) treatment, last stable examination, and the date of massive SRH were reviewed. Imaging findings including indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were analyzed.
Massive SRH developed in 18 eyes (9.6%) a median of 20 months after the initial presentation. Kaplan-Meier survival analysis revealed that the incidence (2.8, 5.8, 13.1, and 21.0% after 1,2,5 and 10 years, respectively) continuously increased. Among 14 eyes with discernable vascular anastomosis on baseline ICGA, 13 (92.8%) showed retinal arteriole involvement. On spectral-domain OCT imaging of the last visit prior to the massive SRH, a layered lamellar tissue complex was noted under the retinal pigment epithelium in 9 of 13 eyes, which was significantly associated with massive SRH[hazard ratio(HR),5.883;P = .010]. The average time between the last stable examination/last injection and the massive SRH was 2 and 5 months, respectively. The patients were treated with anti-VEGF, gas and recombinant tissue plasminogen activator injection; however, all except one eye had visual acuity worse than 20/1000 at the final visit.
Massive SRH can occur in RAP in the course of anti-VEGF treatment, resulting in severe vision loss. A proactive dosing regimen may be more appropriate for these RAP eyes.