Submacular hemorrhage and grape-like polyp clusters: factors associated with reactivation of the lesion in polypoidal choroidal vasculopathy

Abstract

PurposeThe purpose of this study is to investigate the factors associated with reactivation of the lesion during the first year in patients with polypoidal choroidal vasculopathy (PCV) treated with intravitreal ranibizumab.Patients and methodsThis retrospective observational study included 84 eyes diagnosed with PCV and treated with 3-monthly ranibizumab injections. Only those patients who exhibited complete resolution of fluid after initial treatment and were followed up at least 12 months were included. The baseline characteristics of the patients, including their age and sex, location of the polyps, greatest linear dimensions of the lesions, largest polyp diameter, choroidal vascular hyperpermeability, submacular hemorrhages ≥1 disc area in size, presence of grape-like polyp clusters, central foveal thickness, and best-corrected visual acuity were compared between patients with and without reactivation of the lesion.ResultsDuring the 12-month follow-up period, reactivation of the lesion was observed in 60 patients (71.4%). The first reactivation was noted at a mean duration of 3.9±1.7 months after the third ranibizumab injection. Cox regression analysis revealed that the absence of submacular hemorrhages ≥1 disc area (P=0.009), presence of grape-like polyp clusters (P=0.002), and greatest linear dimension of the lesions (P=0.019) were associated with reactivation of the lesion.ConclusionThe absence of submacular hemorrhages, presence of grape-like polyp clusters, and large lesion size at diagnosis were associated with a high risk of reactivation of PCV in patients treated with intravitreal ranibizumab. Patients exhibiting these characteristics may require close monitoring.

Fibrovascular pigment epithelial detachment in eyes with subretinal hemorrhage secondary to neovascular AMD or PCV: a morphologic predictor associated with poor treatment outcomes

“…It is well established that lesion re-activation is not noted in some eyes after initial anti-VEGF treatment 27,28 . In PCV, subretinal hemorrhage is associated with a low risk of lesion reactivation 29 . In the study by Kim et al, lesion re-activation after initial treatment during the first year was noted in 47.8% of the eyes with subretinal hemorrhage 29 .…”

Long-term Clinical Course after Vitrectomy for Breakthrough Vitreous Hemorrhage Secondary to Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy

“…In addition, the proportion of eyes without showing reactivation was relatively higher in the PCV group (46.4%) than in the neovascular AMD group (29.4%). Previous studies have shown that PCVs presenting with submacular hemorrhage may show a different clinical course from those without hemorrhage 15,16,25 . One of the distinguishing characteristics is that the incidence of www.nature.com/scientificreports www.nature.com/scientificreports/ reactivation of the lesion is markedly low in these cases 16,25 .…”

“…Previous studies have shown that PCVs presenting with submacular hemorrhage may show a different clinical course from those without hemorrhage 15,16,25 . One of the distinguishing characteristics is that the incidence of www.nature.com/scientificreports www.nature.com/scientificreports/ reactivation of the lesion is markedly low in these cases 16,25 . In particular, this trend is more pronounced in eyes showing hyperpigmented spots, which suggests degeneration of the retinal pigment epithelial layer and outer retinal layers 15 .…”

“…In particular, this trend is more pronounced in eyes showing hyperpigmented spots, which suggests degeneration of the retinal pigment epithelial layer and outer retinal layers 15 . We previously suggested that decreased functioning of the damaged retinal tissue is one of the causes for the low incidence of reactivation after submacular hemorrhage 16 . In the present study, the included eyes usually exhibited large-sized submacular hemorrhage.…”

“…The examination methods used in this study were similar to those used in our previous studies 15,16 . A comprehensive ophthalmological examination, including the measurement of best-corrected visual acuity (BCVA) and a 90-D-lens slit-lamp biomicroscopy evaluation, was performed on all the patients.…”