Clinical Features and Course of Patients with Peripheral Exudative Hemorrhagic Chorioretinopathy

Abstract

Objectives:To evaluate the clinical characteristics of patients who were followed in our clinic with the diagnosis of peripheral exudative hemorrhagic chorioretinopathy (PEHC).Materials and Methods:Medical records of 12 patients who were diagnosed with PEHC in İstanbul University İstanbul Faculty of Medicine, Department of Ophthalmology between July 2006 and June 2014 were reviewed retrospectively.Results:This study included 21 eyes of 12 patients. Four (33.3%) of the patients were male and 8 (66.7%) were female and ages ranged between 73 and 89 years. Eight (66.7%) of the patients were referred to us with the diagnosis of choroidal mass. Unilateral involvement was found in 3 and bilateral involvement in 9 patients. Temporal quadrants were involved in all eyes. Fifteen eyes (71.4%) had subretinal hemorrhage and hemorrhagic/serous retinal pigment epithelial detachment, 11 (52.4%) had lipid exudation, 5 (23.8%) had chronic retinal pigment epithelium alterations, 2 (9.5%) had subretinal fibrosis and 1 (4.8%) had vitreous hemorrhage. PEHC lesions were accompanied by drusen in 11 eyes (52.4%), geographic atrophy in 2 eyes (9.5%), and choroidal neovascularization scar in 2 eyes (9.5%). Treatment was done in both eyes of a patient for lesions which threatened the macula, in a patient with bilateral macular edema and in a patient with vitreous hemorrhage. The remaining eyes were followed-up without any treatment because the lesions did not threaten the macula and they showed no progression during follow-up.Conclusion:PEHC is a degenerative disease of peripheral retina that is seen in older patients, and signs of age-related macular degeneration (AMD) may accompany this pathology. Especially in patients with AMD findings, the peripheral retina must be evaluated carefully for existing PEHC lesions.

Peripheral Exudative Hemorrhagic Chorioretinopathy with and without treatment—Clinical and multimodal imaging characteristics and prognosis

“…Demographic characteristics and past medical history of our cohort resembled previous descriptions of PEHCR [9,10,14]. An interesting finding was the relatively high prevalence of past malignancy in our cohort (10/32 patients, 31.25%), which has not been mentioned in previous reports of PEHCR.…”

“…Several treatment modalities for PEHCR have been suggested previously, including cryotherapy, laser photoablation and anti-VEGF injections, with no statistically significant impact of either method thus far [8,10,15]. Previous reports have suggested intravitreal anti-VEGF injections as a treatment method to halt PEHCR progression and induce remission, especially in cases involving the macula or extending over a large area [7,9,[14][15][16][17][18]. Except for one [18], all these reports were limited by short follow-up periods and small sample size (1 to 12 eyes), but demonstrated a favorable response to 2-3 injections, with resolution of subretinal fluid, hemorrhages, and some improvement in VA (although not statistically significant), sometimes requiring an additional injection if recurrence was observed.…”

“…Although some patients did exhibit FA and/or ICGA findings consistent with peripheral PCV in the aforementioned studies, the authors admitted that these finding were evident only in a subgroup of patients. Nevertheless, based on this assumed pathophysiology, several attempts at PEHCR treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections have been made [7,9,[14][15][16][17]. All reports thus far have shown favorable, but statistically insignificant results, presumably due to small sample size and a relatively short follow-up time.…”

Serpentine retinal pigment epithelial tear

“…[ 10 11 ] As noted in our case, it is present more often in patients with hypertension and those treated with anticoagulants. [ 5 12 13 ] Annesley reported anticoagulant therapy to be a risk factor for the extended involvement. [ 12 ] The common macular complications include drusens, RPE alterations, macular edema, and epiretinal fibrosis.…”

Peripheral Exudative Hemorrhagic Chorioretinopathy in Asian Populations

“…Many authors have suggested that PEHCR is the peripheral variant of age-related macular degeneration, with an underlying choroidal vascular network responsible for its pathophysiology. 5,6 This is because age-related macular degeneration features, including drusen, RPE abnormalities, and choroidal neovascularization, are often observed in PEHCR, and the exudative nature of the lesions observed in both conditions are similar. Some researchers have suggested that PEHCR is a subtype of polypoidal choroidal vasculopathy (PCV).…”