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Masayasu Kitahashi, Takayuki Baba, Madoka Sakurai-Yanagihashi, Hirotaka Yokouchi, Mariko Kubota-Taniai, Yoshinori Mitamura, Shuichi Yamamoto; Pneumatic Displacement Combined with Intravitreal Bevacizumab for Massive Submacular Hemorrhage due to Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2064.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the effectiveness of pneumatic displacement (PD) combined with intravitreal bevacizumab (IVB) to that of PD alone to treat massive submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV).
Retrospective nonrandomized clinical trial. Thirty-two eyes of 32 patients with a large, thick SMH secondary to PCV were studied. Twenty-two eyes were treated with combined PD and 1.25 mg of intravitreal bevacizumab (PD+IVB), and 10 eyes were treated with PD alone (PD). PD was produced by intravitreal sulfur hexafluoride (SF6). The best-corrected visual acuity (BCVA) and the indocyanine green angiographic (ICGA) findings before and 6 months after the treatment were evaluated.
The difference in the size of the SMH between the two groups at the baseline was not significant (P=0.72).The mean baseline BCVA was 0.84±0.36 in the PD+IVB group and 0.94±0.69 in the PD group (P=0.59). After 1 month, the BCVA was significantly better in the PD+IVB group (0.67±0.50) than in the PD group (1.6±0.79;P<0.001), and after 6 months in the PD+IVB group (0.32±0.33) than in the PD group (0.98 ±0.64; P<0.001). Reading vision (>0.4) was restored in 17 eyes (77.3%) in the PD+IVB group and 2 eyes (20%) in the PD group (P<0.01). An improvement of the BCVA by >0.2 logMAR units was found in 18 eyes (81.8%) in the IVB+PD group and 2 eyes (20%) in the PD group (P<0.001). A complete displacement of blood was successful in 16 eyes (72.7%) in the PD+IVB group and 5 of 10 eyes (50%) in the PD group after 1 month (P=0.39). The number of eyes with a reduction or resolution of the leakage from the polypoidal lesions was significantly higher in the PD+IVB group (18 eyes, 81.8%) than in the PD group (4 eyes, 40%; P=0.016). Additional treatments were required during the 6 months follow-up was significantly fewer (6 eyes; 27.3%) in the PD+IVB group than that (8 eyes; 80%) in the PD group (P <0.001).
The better visual outcome and fewer additional treatments in the combined group suggest that it may be a better therapeutic procedure for eyes with massive SMH due to PCV in the short-term.
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