Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy
Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy
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DOI：
10.1097/01.iae.0000233647.78726.46
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发表时间：
2007-03-01
影响因子：
3.3
通讯作者：
Yoshimura, Nagahisa
中科院分区：
文献类型：
--
作者：
Hirami, Yasuhiko;Tsujikawa, Akitaka;Yoshimura, Nagahisa
目的：探讨息肉状脉络膜血管病(PCV)光动力治疗(PDT)后出血并发症的临床特点及危险因素。方法：回顾分析85例(91只眼)息肉状脉络膜血管病(PCV)患者的临床资料。PCV的诊断基于吲哚青绿血管造影结果，显示分支血管网络终止于息肉样肿胀。最大的线性维度包括所有息肉样病变、渗漏的血管网络和2型脉络膜新生血管。结果：在PDT后的随访期内，91只眼中28只眼(30.8%)出现了术后视网膜下出血。28只眼中22只眼(78.6%)未经治疗视网膜下出血吸收。6只眼(21.4%)因出血导致玻璃体出血，2只眼接受了平坦部玻璃体切除术。单纯视网膜下出血22只眼中18只眼(81.8%)视力维持或提高，术后6只眼玻璃体出血3只眼(50.0%)视力明显下降。各种全身性疾病和使用抗凝剂的药物与这些出血并发症无关。术后有玻璃体积血的患者激光光斑大小明显大于无玻璃体积血的患者(P=0.017)。结论：后发性视网膜病变患者术后视网膜下出血是一种常见的并发症，对视力的影响可能较小。然而，术后出血有时会非常严重，导致玻璃体出血和视力预后不良。当考虑对有较大PCV病变的眼睛进行PDT时，眼科医生应该意识到严重出血并发症的风险。
Purpose: To evaluate the clinical features and risk factors of hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) after photodynamic therapy (PDT).Methods: We retrospectively reviewed data for 91 consecutive eyes of 85 patients who underwent PDT for the treatment of PCV. The diagnosis of PCV was based on indocyanine green angiographic findings, showing a branching vascular network terminating in polypoidal swelling. The greatest linear dimension included all polypoidal lesions, leaking vascular network, and type 2 choroidal neovascularization.Results: During the follow-up period after PDT, postoperative subretinal hemorrhage was seen in 28 (30.8%) of 91 eyes. In 22 (78.6%) of these 28 eyes, subretinal hemorrhage was absorbed without treatment. In 6 eyes (21.4%), however, bleeding resulted in vitreous hemorrhage, and 2 eyes underwent pars plana vitrectomy. Although visual acuity was maintained or increased in 18 (81.8%) of 22 eyes with subretinal hemorrhage alone, it decreased significantly in 3 (50.0%) of 6 eyes with postoperative vitreous hemorrhage. Various systemic diseases and medication with an anticoagulant had no correlation with these hemorrhagic complications. Laser irradiation spot size for PDT was significantly larger in eyes with postoperative vitreous hemorrhage (P = 0.017) than in those without.Conclusion: Subretinal hemorrhage after PDT can be a common complication in patients with PCV and may have a minor effect on visual outcome. However, postoperative hemorrhage is occasionally so massive that it leads to vitreous hemorrhage and poor visual prognosis. When considering PDT for eyes with a large PCV lesion, ophthalmologists should be aware of the risk of serious hemorrhagic complications.