Management of Massive Submacular Hemorrhage Secondary to Polypoidal Choroidal Vasculopathy by Sequential Pneumatic Displacement and Photodynamic Therapy: A Case Series of One Year Follow–Up

Abstract

Abstract: : Purpose: To evaluate the efficacy of two–stage management with intravitreal injection of perfluoropropane (C₃F₈) gas and photodynamic therapy (PDT) using verteporfin for polypoidal choroidal vasculopathy (PCV) with massive submacular hemorrhage. Methods: Consecutive patients with thick submacular hemorrhage secondary to PCV were displaced pneumatically with intravitreal injection of 100%, 0.4 ml C₃F_8. Fluorescein angiography (FA) and indocyanine green angiography (ICG–A) were repeated 1– 2 weeks later to delineate any persistent active leaking polypoidal lesions, which were then treated with standard PDT regimen. Patients received regular follow–up at every 3–month, retreatment was considered if FA and ICG–A showed evidence of active vascular lesions. Outcome measures include the proportion of patients who had improvement or loss in vision at the one–year follow–up and the changes in best–corrected visual acuity (BCVA) from baseline. Results: : Six eyes of six patients were recruited and all had completed one–year follow–up. The mean age of the patients was 53.6 years (range, 47–64 years). The mean baseline Snellen BCVA was 13/200 and the mean final BCVA was 20/56. The mean improvement in logMAR BCVA after the sequential treatments was 7 lines (range, +3 to +19 lines) (Wilcoxon signed–ranks test, P= 0.03). All patients had at least moderate visual gains. No patient suffered serious ocular or systemic complications from PDT. Conclusions: : Sequential treatments for massive submacular hemorrhage of PCV were safe and well–tolerated in firstly displacing the subfoveal hemorrhage with intravitreal gas injection and then permitting definitive PDT for underlying persistent PCV. A larger sample size, comparative study is warranted in order to compare the long–term efficacy and safety with other treatment modalities.

Keywords: photodynamic therapy • choroid: neovascularization