Long-term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy

Abstract

Importance: There is no consensus on the optimal management of submacular haemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV).

Background: To compare the long-term outcome of three treatment strategies for PCV with SMH.

Design: Retrospective case series at two tertiary hospitals.

Samples: A total of 48 consecutive eyes treated between July 2006 and March 2016.

Methods: Patients were grouped according to the treatment received: 22 eyes with intravitreal bevacizumab (IVB), 14 with a combination of IVB and pneumatic displacement (PD) and 12 with IVB and vitrectomy (TPPV).

Main outcome measures: Change in best-corrected visual acuity (BCVA) at onset and up to 24 months. Secondary measures included demographic data, imaging data and complications.

Results: Comparing the mean BCVAs of the groups revealed significant differences only at month 1 (P = 0.005). Changes in the mean BCVA over time revealed no significance in the resulting final BCVA (P = 0.062), which was 20 out of 155 (logMAR 0.89 ± 0.64) for IVB monotherapy, 20 out of 174 (0.94 ± 1.04) for combined IVB + PD, and 20 out of 195 (0.99 ± 0.90) for combined IVB + TPPV eyes. Sustained long-term improvement of over three Snellen lines was found in seven (31.82%) IVB monotherapy, 10 (71.43%) combined IVB + PD, and seven (58.33%) combined IVB + TPPV eyes (P = 0.043). SMH recurrence was observed in two eyes after IVB monotherapy and one eye after combined IVB + PD (P = 0.786).

Conclusions and relevance: IVB monotherapy appears to be as effective as combination therapies for treating SMH secondary to PCV with regards to BCVA at 24 months, and may be a cost-effective strategy for long-term management.

Keywords: bevacizumab; choroid; macular degeneration; neovascularization; retina.