Subretinal Hemorrhage After Photodynamic Therapy for Age-Related Macular Degeneration

Jae Moon Yoon; Ho Soong Kim; Jae Hoon Kang; Hee Sung Yoon

doi:10.3341/jkos.2008.49.10.1603

Journal List > J Korean Ophthalmol Soc > v.49(10) > 1008101

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Moon Yoon, Soong Kim, Hoon Kang, and Yoon: Subretinal Hemorrhage After Photodynamic Therapy for Age-Related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2008;49(10):1603-1610.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.10.1603

Subretinal Hemorrhage After Photodynamic Therapy for Age-Related Macular Degeneration

Jae Moon Yoon, M.D, Ho Soong Kim, M.D, Jae Hoon Kang, M.D, Hee Sung Yoon, M.D., Ph.D

Sungmo Eye Hospital, Pusan, Korea

Address reprint requests to Hee Sung Yoon, M.D., Ph.D. Sungmo Eye Hospital #1078-7 Woo2-dong, Haeundae-gu, Pusan 612-022, Korea Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: heesyoon@dreamwiz.com

Received 2 July 2008 Accepted 25 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical features of subretinal hemorrhage after photodynamic therapy in eyes with exudative age-related macular degeneration.

Methods

We retrospectively reviewed data for 267 eyes of 243 patients who had undergone PDT for the treatment of ARMD between January 2005 and December 2006. Best corrected visual acuity, fundus photography, fluorescein angiography, and ICG angiography were performed before and after treatment. We followed up the patients at 1 week, 1 month, and 3 months after treatment and at 3-month intervals thereafter.

Results

Postoperative subretinal hemorrhage was seen in 36 (13.4%) of 267 eyes. The pretreatment and post-treatment mean visual acuities were logMAR 0.80 and logMAR 1.05 respectively, representing a decrease of 2.05 lines. On FAG, two eyes were predominantly classic, four eyes were minimally classic, and 30 eyes were occult. The laser irradiation spot size was under 3,000 µm in one case and from 3,000 µm to 5,000 µm in 19 cases and over 5,000 µm in 16 eyes.

Conclusions

Subretinal hemorrhage after PDT for ARMD can be a common complication in patients who have been treated for larger irradiation spot sizes and for pigment epithelial detachment (PED), so doctors should be aware of the risk of serious hemorrhagic complications in such situations.

Keywords: Age-Related Macular, Degeneration, Photodynamic Therapy, Subretinal hemorrhage

References

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Figure 1.

(A) Subretinal hemorrhage less than 2 disc diameter. (B) Subretinal hemorrhage more than 2 disc diameter. (C) Subretinal hemorrhage extends beyond the temporal vascular arcades. (D) Subretinal hemorrhage with vitreous hemorrhage.

Figure 2.

The fluorescein angiographic classification of age related macular degeneration which had subretinal hemorrhage after photodynamic therapy.

Figure 3.

The indocyanine green angiographic classification of age related macular degeneration which had subretinal hemorrhage after photodynamic therapy. (CNV=choroidal neovascularization; PCV=polypoidal choroidal vasculopathy; RAP=retinal angiomatous proliferation; PED=pigment epithelial detachment)

Table 1.

Demographics of the patients who had a retinal hemorrhage after photodynamic therapy

Number of patients*	36 (13.4%)
Age (years)	63.12±5.2 (45-74)
Sex (M:F)	25:11
Preop BSCVA^† (logMAR)	0.80
Postop BSCVA (logMAR)	1.05
Change of VA^‡ (lines)	2.05

^* Patients who had hemorrhage after photodynamic therapy

^† BSCVA=best spectacle-corrected visual acuity

^‡ Change of VA=difference between pre-operative BSCVA and post- operative BSCVA.

Table 2.

Onset of hemorrhage after photodynamic therapy

Onset of hemorrhage after PDT*	Eyes (percent)
<1 week	9/36 (25.0%)
1 week ≤ ~ < 1 month	7/36 (19.4%)
≥ 1 month	20/36 (55.6%)

^* PDT=photodynamic therapy.

Table 3.

Extent of hemorrhage after photodynamic therapy

Extent of hemorrhage	Eye (percent)
< 2 disc diameter	18/36 (50.0%)
≥2 disc diameter	9/36 (25.0%)
Massive hemorrhage*	3/36 (8.3%)
Vitreous hemorrhage^†	6/36 (16.7%)

^* subretinal hemorrhage extends beyond the temporal vascular arcades

^† subretinal hemorrhage with vitreous hemorrhage.

Table 4.

Spot size of laser

Spot size of laser (µm)	Eye (percent)
< 3,000	1/36 (2.7%)
3,000 ≤ ~ < 5,000	19/36 (52.8%)
≥ 5,000	16/36 (44.5%)

Table 5.

Comparison of published retinal hemorrhage rate after photodynamic therapy of age related macular degeneration

Author	Reference No	No. of treated eyes	Follow-up	Hemorrhage rate	Hemorrhage type
This study		267	6~26 mo*	36 (13.4%)	subretinal, vitreous
TAP study group	16	402	3 mo	116 (29%)	subretinal, intraretinal
Theodossiadis	17	215	48 hr^†	4 (1.86%)	extensive macular
Bressler	18	55	2~3 mo	5 (9%)	large submacular
Gelisken	19	104	2 wk^‡	23 (22%)	new subfoveal
Diaz	20	504	34 mo	8 (1.58%)	submacular
JAT study group	21	64	12 mo	1 (1.56%)	subretinal
Kim	22	21	3~15 mo	4 (19.0%)	subretinal, vitreous

^* mo=months

^† hr=hours

^‡ wk=weeks.

Table 6.

The relation between onset of hemorrhage and extent of hemorrhage after photodynamic therapy

Onset of hemorrhage	Eyes (percent)	Extent of hemorrhage
<1 week	9/36 (25.0%)	7 eyes < 2DD
		2 eyes ≥ 2DD
		0 eye Massive hemorrhage*
		0 eye Vitreous hemorrhage^†
1 week ≤ ~ < 1 month	7/36 (19.4%)	5 eyes < 2DD
		2 eyes ≥ 2DD
		0 eye Massive hemorrhage*
		0 eye Vitreous hemorrhage^†
≥ 1 month	20/36 (55.6%)	6 eyes < 2DD
		5 eyes ≥ 2DD
		3 eyes Massive hemorrhage*
		6 eyes Vitreous hemorrhage^†

^* subretinal hemorrhage extends beyond the temporal vascular arcades

^† subretinal hemorrhage with vitreous hemorrhage.

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