Abstract
Purpose :
Subretinal endoscopic surgery, reported by Kaga et al (Retina, in press), is useful for thoroughly removing a subretinal hemorrhage (SRH) and a fibrovascular pigment epithelium detachment (PED), including choroidal neovascularization (CNV), without a large retinotomy in patients with a SRH due to age-related macular degeneration (AMD). The ophthalmic endoscope can also provide an unique and detailed subretinal view during surgery. We report our findings on two cases of polypoidal choroidal vasculopathy (PCV) with intraoperative subretinal images directly observed by ophthalmic endoscope.
Methods :
Case 1: A 78 year-old female with a large SRH and a visual acuity of 20/250 in her left eye, the SRH occurred in spite of monthly intravitreal aflibercept treatment. Case 2: A 72 year-old male with an old SRH and a visual acuity of 20/133 in his left eye. Subretinal endoscopic surgery was performed for these patients and subretinal lesions were directly observed in detail by the ophthalmic endoscope. We correlated the intraoperative endoscopic images with preoperative assessment and postoperative follow up images.
Results :
Case 1: The SRH and a fibrovascular PED were removed. A presumed feeder vessel from the choroid to CNV and a bleeding point from Bruch’s membrane rupture, which appeared to be the origin of the branching vascular network (BVN) could be observed. Visual acuity 1 month after surgery was 20/100. We could confirm the difference of choroidal vessels and BVN by comparing the intraoperative subretinal images, the pre- and postoperative images of indocyanine green angiography (ICGA). Case 2: The SRH was removed. Polypoidal lesions and BVN under the RPE could be directly observed. The choroidal vessels which seemed to be the origin of BVN and polypoidal lesions were coagulated. As a consequence from this procedure, we confirmed absence of blood flow in BVN, due to these coagulated lesions, by ICGA images postoperatively. The visual acuity 1 month after surgery was 20/250.
Conclusions :
In two cases of PCV, the presumed feeder vessel, polypoidal lesions and BVN under the retina could be directly observed in detail by the ophthalmic endoscope. In addition, new understanding of PCV complex was obtained by direct intraoperative visualization.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.