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T. Hasegawa, A. Otani, M. Sasahara, S. Ooto, H. Tamura, K. Yamashiro, A. Tsujikawa, N. Yoshimura; Prognostic Factors of Vitreous Hemorrhage Secondary to Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):941.
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Vitreous hemorrhage (VH) is a rare but serious complication in the eyes with exudative age-related macular degeneration (AMD), although the mechanisms of the occurrence of VH remain unclear. There are various clinical courses resulting in VH in the eyes with exudative AMD. The current study was designed to evaluate various clinical factors that may affect the visual prognosis in the patients with VH secondary to exudative AMD.
We intensively documented the cases of VH secondary to exudative AMD and retrospectively analyzed best-corrected visual acuity (BCVA). All the eyes underwent standard pars plana vitrectomy (PPV) for treating VH. Three subgroups were made by the clinical course before the occurrence of VH; (1) Gas group: Pneumatic displacement with SF6 gas was performed to treat massive submacular hemorrhage before the occurrence of VH. (2) PDT group: PDT was performed to treat exudative AMD before the occurrence of VH. (3) Untreated group: No treatment was performed before the occurrence of VH.
Thirty-one eyes of 31 patients were included in the study (Age; 73.8±7.7 years, Male; 84%). Postoperative follow-up periods were 19.9±14.2 months. Sixteen patients (52%) had bilateral exudative AMD. Angiographic analysis revealed that 22 eyes (71%) manifested polypoidal choroidal vasculopathy (PCV) pattern. As a history of treatment before the occurrence of VH, Gas group was 7 eyes (23%), PDT group was 9 eyes (29%), and Untreated group was 15 eyes (48%). As a whole, the BCVA before the occurrence of VH was 1.05±0.59 (LogMAR). After the occurrence of VH, the BCVA before PPV was 2.61±0.82. After the operation, the final BCVA significantly improved to 1.25±0.73 (P<10-8). In the subgroup analysis, no statistically significant difference was seen in the 3 subgroup in any time point. We found that the eyes whose fellow eye had exudative AMD showed significantly poor final BCVA compared to unilateral cases (0.92±0.57 and 1.49±0.72, P=0.02). Multivariate regression analysis detected no statistically significantly factors.
PPV can improve visual acuity in the eyes with VH secondary to AMD, although the effectiveness is limited. The clinical courses before the occurrence of VH may not affect the visual prognosis. The clinicians should be careful for the visual prognosis especially when the cases are bilaterally affected.
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