Skip to main content

Advertisement

SpringerLink
Log in

Simultaneous intravitreal aflibercept and gas injections for submacular hemorrhage secondary to polypoidal choroidal vasculopathy

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the outcomes of intravitreal aflibercept and gas injections for submacular hemorrhage (SMH) associated with polypoidal choroidal vasculopathy (PCV).

Methods

We retrospectively reviewed the medical records of 22 eyes with SMH secondary to PCV that underwent intravitreal aflibercept and 100% perfluoropropane (0.3–0.5 mL) followed by 3-day prone positioning from August 2013 through November 2020. The primary outcome measure was best-corrected visual acuity (BCVA) at 12 months.

Results

The average SMH size was 13.0 ± 9.7 (range, 2.0–37.8) disc diameter. The complete, partial, and no displacement of the SMH was observed in 8 (36%) eyes, 9 (41%) eyes, and 5 (23%) eyes, respectively. The BCVA (logarithm of the minimum angle of resolution) continuously improved significantly from 0.81 ± 0.41 (Snellen equivalent, 20/125) at baseline to 0.48 ± 0.44 (20/60), 0.33 ± 0.39 (20/43), and 0.28 ± 0.45 (20/38), at 3, 6, and 12 months, respectively (P = 0.01 for 3 months; P < 0.001 for 6 and 12 months). The BCVA improved by 3 or more lines in 14 eyes (64%). Two eyes (9%) developed visually significant vitreous hemorrhage, and 1 (5%) eye developed rhegmatogenous retinal detachment; all were successfully treated with vitrectomy. The better BCVA at 12 months tended to be associated with lower height of the SMH at baseline (R2 = 0.171, P = 0.056) and a greater displacement of SMH (R2 = 0.244, P = 0.069). Worse BCVA at 12 months was associated with anticoagulant medication (P < 0.001).

Conclusions

Intravitreal aflibercept and gas injections are effective and relatively safe for SMH associated with PCV, resulting in significant visual improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Yannuzzi LA, Sorenson J, Spaide RF, Lipson B (1990) Idiopathic polypoidal choroidal vasculopathy (IPCV). Retin 10:1–8. https://doi.org/10.1097/00006982-199001010-00001

    Article  CAS  Google Scholar 

  2. Cheung CMG, Lai TYY, Ruamviboonsuk P et al (2018) Polypoidal choroidal vasculopathy definition, pathogenesis, diagnosis, and management. Ophthalmology 125:708–724. https://doi.org/10.1016/j.ophtha.2017.11.019

    Article  PubMed  Google Scholar 

  3. Maruko I, Iida T, Saito M et al (2007) Clinical characteristics of exudative age-related macular degeneration in Japanese patients. Am J Ophthalmol 144:15-22.e2. https://doi.org/10.1016/j.ajo.2007.03.047

    Article  PubMed  Google Scholar 

  4. Coscas G, Yamashiro K, Coscas F et al (2014) Comparison of exudative age-related macular degeneration subtypes in Japanese and French patients: multicenter diagnosis with multimodal imaging. Am J Ophthalmol 158:309-318.e2. https://doi.org/10.1016/j.ajo.2014.05.004

    Article  PubMed  Google Scholar 

  5. Li Y, You QS, Wei WB et al (2014) Polypoidal choroidal vasculopathy in adult Chinese: the Beijing eye study. Ophthalmol 121:2290–2291. https://doi.org/10.1016/j.ophtha.2014.06.016

    Article  Google Scholar 

  6. Ciardella AP, Donsoff IM, Huang SJ et al (2004) Polypoidal choroidal vasculopathy. Surv Ophthalmol 49:25–37. https://doi.org/10.1016/j.survophthal.2003.10.007

    Article  PubMed  Google Scholar 

  7. Sho K, Takahashi K, Yamada H et al (2003) Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol-chic 121:1392–1396. https://doi.org/10.1001/archopht.121.10.1392

    Article  Google Scholar 

  8. Cho SC, Cho J, Park KH, Woo SJ (2021) Massive submacular haemorrhage in polypoidal choroidal vasculopathy versus typical neovascular age-related macular degeneration. Acta Ophthalmol 99:e706–e714. https://doi.org/10.1111/aos.14676

    Article  PubMed  Google Scholar 

  9. Cho JH, Ryoo N-K, Cho KH et al (2016) Incidence rate of massive submacular hemorrhage and its risk factors in polypoidal choroidal vasculopathy. Am J Ophthalmol 169:79–88. https://doi.org/10.1016/j.ajo.2016.06.014

    Article  PubMed  Google Scholar 

  10. Kitahashi M, Sakurai M, Yokouchi H et al (2014) Pneumatic displacement with intravitreal bevacizumab for massive submacular hemorrhage due to polypoidal choroidal vasculopathy. Clin Ophthalmol 8:485–492. https://doi.org/10.2147/opth.s55413

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kang HG, Kang H, Byeon SH et al (2018) Long-term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy. Clin Exp Ophthalmol 46:916–925. https://doi.org/10.1111/ceo.13198

    Article  PubMed  Google Scholar 

  12. Kimura S, Morizane Y, Hosokawa MM et al (2019) Outcomes of vitrectomy combined with subretinal tissue plasminogen activator injection for submacular hemorrhage associated with polypoidal choroidal vasculopathy. Jpn J Ophthalmol 63:382–388. https://doi.org/10.1007/s10384-019-00679-2

    Article  CAS  PubMed  Google Scholar 

  13. Matsuo Y, Haruta M, Ishibashi Y et al (2021) Visual outcomes and prognostic factors of large submacular hemorrhages secondary to polypoidal choroidal vasculopathy. Clin Ophthalmol 15:3557–3562. https://doi.org/10.2147/opth.s327138

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kitagawa Y, Shimada H, Mori R et al (2016) Intravitreal tissue plasminogen activator, ranibizumab, and gas injection for submacular hemorrhage in polypoidal choroidal vasculopathy. Ophthalmol 123:1278–1286. https://doi.org/10.1016/j.ophtha.2016.01.035

    Article  Google Scholar 

  15. Kimura S, Morizane Y, Hosokawa M et al (2015) Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator. Am J Ophthalmol 159:683-689.e1. https://doi.org/10.1016/j.ajo.2014.12.020

    Article  CAS  PubMed  Google Scholar 

  16. Cho HJ, Koh KM, Kim HS et al (2013) Anti–vascular endothelial growth factor monotherapy in the treatment of submacular hemorrhage secondary to polypoidal choroidal vasculopathy. Am J Ophthalmol 156:524-531.e1. https://doi.org/10.1016/j.ajo.2013.04.029

    Article  CAS  PubMed  Google Scholar 

  17. Choi YJ, Hyun J, Choi KS et al (2013) Bullous hemorrhagic retinal detachment because of massive subretinal hemorrhage in patients with age-related macular degeneration. Retin 33:1365–1374. https://doi.org/10.1097/iae.0b013e31827b640c

    Article  Google Scholar 

  18. Group SST (SST) R (2004) Surgery for hemorrhagic choroidal neovascular lesions of age-related macular degeneration: ophthalmic findings SST report no. 13. Ophthalmol 111:1993-2006.e1. https://doi.org/10.1016/j.ophtha.2004.07.023

    Article  Google Scholar 

  19. Ohji M, Saito Y, Hayashi A et al (1998) Pneumatic displacement of subretinal hemorrhage without tissue plasminogen activator. Arch Ophthalmol-chic 116:1326–1332. https://doi.org/10.1001/archopht.116.10.1326

    Article  CAS  Google Scholar 

  20. Yamamoto A, Okada AA, Kano M et al (2015) One-year results of intravitreal aflibercept for polypoidal choroidal vasculopathy. Ophthalmol 122:1866–1872. https://doi.org/10.1016/j.ophtha.2015.05.024

    Article  Google Scholar 

  21. Oishi A, Tsujikawa A, Yamashiro K et al (2015) One-year result of aflibercept treatment on age-related macular degeneration and predictive factors for visual outcome. Am J Ophthalmol 159:853-860.e1. https://doi.org/10.1016/j.ajo.2015.01.018

    Article  CAS  PubMed  Google Scholar 

  22. Kim JH, Kim CG, Lee DW et al (2020) Intravitreal aflibercept for submacular hemorrhage secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefe’s Archive Clin Exp Ophthalmol 258:107–116. https://doi.org/10.1007/s00417-019-04474-0

    Article  CAS  Google Scholar 

  23. Wu T-T, Kung Y-H, Hong M-C (2011) Vitreous hemorrhage complicating intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage. Retin 31:2071–2077. https://doi.org/10.1097/iae.0b013e31822528c8

    Article  Google Scholar 

  24. Cheung CMG, Lai TYY, Teo K et al (2021) Polypoidal choroidal vasculopathy consensus nomenclature and non–indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup. Ophthalmol 128:443–452. https://doi.org/10.1016/j.ophtha.2020.08.006

    Article  Google Scholar 

  25. Chang W, Garg SJ, Maturi R et al (2014) Management of thick submacular hemorrhage with subretinal tissue plasminogen activator and pneumatic displacement for age-related macular degeneration. Am J Ophthalmol 157:1250–1257. https://doi.org/10.1016/j.ajo.2014.02.007

    Article  CAS  PubMed  Google Scholar 

  26. Treumer F, Roider J, Hillenkamp J (2012) Long-term outcome of subretinal coapplication of rtPA and bevacizumab followed by repeated intravitreal anti-VEGF injections for neovascular AMD with submacular haemorrhage. Brit J Ophthalmol 96:708. https://doi.org/10.1136/bjophthalmol-2011-300655

    Article  Google Scholar 

  27. He X, Hahn P, Iacovelli J et al (2007) Iron homeostasis and toxicity in retinal degeneration. Prog Retin Eye Res 26:649–673. https://doi.org/10.1016/j.preteyeres.2007.07.004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Chaikitmongkol V, Upaphong P, Patikulsila D et al (2021) Timing of complete polypoidal regression following intravitreous aflibercept treatments in polypoidal choroidal vasculopathy. Ophthalmol Retin. https://doi.org/10.1016/j.oret.2021.03.012

    Article  Google Scholar 

  29. Cho JH, Park YJ, Cho SC et al (2018) Posttreatment polyp regression and risk of massive submacular hemorrhage in eyes with polypoidal choroidal vasculopathy. Retin 40(3):468–476. https://doi.org/10.1097/iae.0000000000002384

    Article  Google Scholar 

  30. González-López JJ, McGowan G, Chapman E, Yorston D (2016) Vitrectomy with subretinal tissue plasminogen activator and ranibizumab for submacular haemorrhages secondary to age-related macular degeneration: retrospective case series of 45 consecutive cases. Eye 30:929–935. https://doi.org/10.1038/eye.2016.65

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Haupert CL, McCuen BW, Jaffe GJ et al (2001) Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid–gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration. Am J Ophthalmol 131:208–215. https://doi.org/10.1016/s0002-9394(00)00734-0

    Article  CAS  PubMed  Google Scholar 

  32. Steel D (2010) Displacement of submacular hemorrhage associated with age-related macular degeneration using vitrectomy and submacular tPA injection followed by intravitreal ranibizumab. Clin Ophthalmol 4:637–642. https://doi.org/10.2147/opth.s10060

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan

    Taku Wakabayashi, Chikako Hara, Akihiko Shiraki, Nobuhiko Shiraki, Kaori Sayanagi, Susumu Sakimoto, Shigeru Sato, Hirokazu Sakaguchi & Kohji Nishida

  2. Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA

    Taku Wakabayashi

  3. Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan

    Kohji Nishida

Authors
  1. Taku Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chikako Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akihiko Shiraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nobuhiko Shiraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kaori Sayanagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susumu Sakimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shigeru Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirokazu Sakaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kohji Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chikako Hara.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the (place name of institution and/or national research committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wakabayashi, T., Hara, C., Shiraki, A. et al. Simultaneous intravitreal aflibercept and gas injections for submacular hemorrhage secondary to polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 261, 1545–1552 (2023). https://doi.org/10.1007/s00417-022-05922-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-022-05922-0

Keywords

Search

Navigation