Relationship between hypertension and recurrent subretinal hemorrhage in polypoidal choroidal vasculopathy

Abstract

 

Purpose

 

Recurrent subretinal hemorrhage, one of the clinical manifestations in polypoial choroidal vasculopathy(PCV), can sometimes severely devastate macula and deteriorate visual outcome. We hypothesize that a history of hypertension or high blood pressure could be related to the recurrent subretinal hemorrhage and performed a retrospective, observational clinical study to investigate the relationship between hypertension and recurrent subretinal hemorrhage in eyes with PCV after anti-VEGF treatment or photodymic therapy (PDT).

 

Methods

 

Thirty eight patients with PCV who had received intravitreal anti-VEGF (bevacizumab or ranibizumab) treatment or photodaymic therapy or both from Jan 1^st, 2011 to Dec 31^th, 2013 were reviewed. The diagnosis of PCV was based on indocyanine green angiographic findings, showing a branching vascular network terminating in polypoidal swelling. A relationship between hypertension and the recurrent subretinal hemorrhage as well as other variables such as systolic and diastolic blood pressure, other systemic diseases, a number of injections and medication histories was documented and analyzed. Chi-square analysis and Kaplan-Meier survival analysis were used for statistical analysis.

 

Results

 

The mean follow-up was 13.2±2.9 months(including telephone research, range, 13.2 to 71.6 months) and the mean SBP and DBP was 131.6±2.7 mmHg(range, 105 to 167 mmHg) and 74.9±1.7mmHg(range, 46 to 103 mmHg), respectively. During the follow-up period, recurrent subretinal hemorrhage was observed in 14(36.8%) of 38 eyes. Occurrence of recurrent subretinal hemorrhage was significantly increased in the group with hypertension (known systemic hypertension or systolic blood pressure over 150mmHg) (P=0.027, Chi-square analysis). Median survival time to recurrent subretinal hemorrhage was 20.6months with hypertension and 68.6months without hypertension (P=0.021, Kaplan-Meier survival analysis). Other systemic disease, number of injection and medication history had no correlation with recurrent subretinal hemorrhage.

 

Conclusions

 

Hypertension is associated with recurrent subretinal hemorrhage in PCV who was treated with anti-VEGF treatment, PDT or combined therapy. Further, hypertension might make the recurrent subretinal hemorrhage earlier. When deciding treatment or follow-up for PCV, the history of hypertension and blood pressure should be considered.