Abstract
Purpose:
To investigate the efficacy of pneumatic displacement with anti-vascular endothelial growth factor (VEGF) therapy with ranibizumab or aflibercept for subretinal hemorrhage (SRH) secondary to polypoidal choroidal vasculopathy (PCV) as initial treatment.
Methods:
Medical records of patients with SRH secondary to PCV were retrospectively reviewed. Treatment-naïve eyes underwent intravitreal injection of ranibizumab 0.5 mg/0.05 mL (IVR) or aflibercept 2 mg/0.05 mL (IVA) followed by pure C3F8 gas 0.3-0.5 mL as initial treatment and followed-up at least 6 months. Additional IVR or IVA was performed as needed. Pre-post best corrected visual acuity (BCVA), anatomical changes measured by optical coherence tomography (OCT), and the incidence of recurrent SRH were analyzed.
Results:
Twelve eyes of 11 patients were included. The mean (±standard deviation) age was 72.6±7.4 years old (range, 57-82). The mean baseline BCVA was 0.78±0.37 logMAR (range, 0.40-1.40). The mean follow up period was 28.5±16.8 months (range, 6-56). The mean numbers of intravitreal injections were 4.8±3.7 times (range, 1-3.7). Of anti-VEGF therapy, 9 eyes (75%) were treated with IVR alone and 2 eyes (17%) were treated with IVA alone. The treatment was switched from IVR to IVA in one eye (8%). SRHs were displaced from macular area in all eyes. Visual acuity was improved by 0.3 logMAR units or more in 6 eyes (50%) but was unchanged in 4 eyes (33%) and were worsened by 0.3 logMAR units or more in 2 eyes (17%) at final visit. No statistical significant difference was found in mean BCVA between pretreatment and final visit (P = 0.12). Pigment epithelial detachments measured by OCT were disappeared in 8 eyes (67%), of which 6 eyes improved BCVA by 0.3 logMAR or more at final visit. None of 4 eyes with persistent PEDs gained visual improvement by 0.3 logMAR or more at final visit. No recurrence of SRH was found during the follow-up period.
Conclusions:
Pneumatic displacement in combination with anti-VEGF therapy may effective for anatomical and visual improvement and also prevent recurrence for SRH secondary to PCV.