The Effect of Triple Therapy on Patients with Subretinal Hemorrhage Accompanied by Choroidal Neovascularization

Eun Seok Yoo; Dong Won Lee

doi:10.3341/JKOS.2011.52.4.442

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Yoo and Lee: The Effect of Triple Therapy on Patients with Subretinal Hemorrhage Accompanied by Choroidal Neovascularization

Original Article

J Korean Ophthalmol Soc 2011;52(4):442-447.

Published online: 6 September 2011

DOI: https://doi.org/10.3341/JKOS.2011.52.4.442

The Effect of Triple Therapy on Patients with Subretinal Hemorrhage Accompanied by Choroidal Neovascularization

Eun Seok Yoo, M.D., Dong Won Lee, MD, PhD

Department of Ophthalmology, Konyang University, Kim’s Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea

Address reprint requests to Dong Won Lee, MD, PhD Department of Ophthalmology, Kim’s Eye Hospital #156 Yeongdeungpo-dong 4-ga, Yeongdeungpo-gu, Seoul 150-034, Korea Tel: 82-2-2639-7777, Fax: 82-2-2633-3976, E-mail: mediceye@kimeye.com

Received 3 May 201018 August 2010 Accepted 17 February 2011

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 presents the effect of triple therapy including C₃ F₈ gas injection, intravitreal anti-VEGF injection and photodynamic therapy on patients with subretinal hemorrhage accompanied by choroidal neovascularization.

Methods

Twelve eyes of 12 patients suffering from subretinal hemorrhage accompanied by choroidal neovascularization with onset of the symptom within a week prior to three-day prone positioning after C₃ F₈ gas injection were included in the present study. Next, intravitreal anti-VEGF injection and photodynamic therapy was performed. Then, within two months, intravitreal bevacizumab or ranibizumab injection was performed.

Results

After stabilization of the submacular hemorrhagic lesion, ten eyes of ten patients showed improved visual acuity, one eye showed no improvement, and decreased visual acuity developed in one patient. LogMAR visual acuity improved after the initial treatment from 1.05 ± 0.43 to 0.74 ± 0.58 and 0.53 ± 0.51 at three and six months, respectively. The improvement was considered to be clinically significant.

Conclusions

An appropriate regimen for treating broad submacular hemorrhage accompanied by choroidal neovascularization has not been established. The authors of the patients had obtained positive results from C₃ F₈ gas injection, intravitreal anti-VEGF injection and photodynamic therapy. In the future, additional studies should be conducted.

Keywords: Anti-VEGF injection, CNV (Choroidal neovascularization), Gas injection, PDT (photodynamic therapy), Subretinal hemorrhage

References

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Figure 1.

Case 1 preoperation and post-operation fundus photograph, OCT, FAG and HRA. (A) Fundus photography, (B) OCT, (C) FAG (early phase), (D) HRA ICG (early phase), (E) FAG (late phase), (F) HRA ICG (late phase).

Figure 2.

Changes from baseline visual acuity at 6 months of follow-up (n = 12).

Table 1.

Baseline demographics for patients

case	Sex/age	Hemorrhage Diameter (DD)	BCVA^§(initial)	Systemic Disease		Anti- VEGF	F/U (months)
case	Sex/age	Hemorrhage Diameter (DD)	BCVA^§(initial)	HTN	DM	Anti- VEGF	F/U (months)
1	F/47	3	20/80	N^†	Y^‡	Bevacizumab	12
2	M/79	3.5	FC^*	N	N	Bevacizumab	13
3	F/42	3.2	FC	N	N	Bevacizumab	7
4	F/77	5.5	FC	Y	N	Bevacizumab	10
5	M/79	3	FC	Y	Y	Bevacizumab	13
6	M/67	3.1	20/50	N	N	Bevacizumab	8
7	M/60	4	20/200	N	N	Bevacizumab	18
8	M/67	3	20/100	Y	N	Bevacizumab	10
9	M/74	4	10/200	Y	N	Bevacizumab	16
10	F/49	3	20/100	N	N	Ranibizumab	9
11	F/49	3	20/100	N	N	Ranibizumab	10
12	F/62	3.3	10/200	Y	Y	Bevacizumab	11

^* FC = finger count/30;

^† N = no;

^‡ Y = yes;

^§ BCVA = best corrected visual acuity.

Table 2.

Frequency distribution of changes in visual acuity from baselines

Changes in visual acuity from baseline to month 6	No. of treated eyes (n = 12)
V/A^* improvement (n = 10)
≥ Six line increase	1 (8.33%)
Four to < six line increase	4 (33.33%)
Two to < four line increase	5 (41.67%)
No change (< two line increase)	1 (8.33%)
V/A^* loss	1 (8.33%)

^* V/A = visual acuity.

Table 3.

Changes in visual acuity

	Visual acuity (mean±SD, logMAR)	p value
Prior to injection	1.05 ± 0.43
6 months after injection	0.74 ± 0.58	0.062^*
12 months after injection	0.53 ± 0.51	0.006^*

^* Paired t test.

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