Characteristics of Polypoidal Choroidal Vasculopathy Associated with Subretinal Hemorrhage

Woo Gon Choi; Young Wook Cho; Ji Hye Jang

doi:10.3341/jkos.2015.56.7.1051

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Choi, Cho, and Jang: Characteristics of Polypoidal Choroidal Vasculopathy Associated with Subretinal Hemorrhage

Original Article

J Korean Ophthalmol Soc 2015;56(7):1051-1058.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1051

Characteristics of Polypoidal Choroidal Vasculopathy Associated with Subretinal Hemorrhage

Woo Gon Choi, M.D, Young Wook Cho, M.D, Ji Hye Jang, M.D

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea

Address reprint requests to Ji Hye Jang, MD Department of Ophthalmology, Daegu Fatima Hospital, #99 Ayang-ro, Dong-gu, Daegu 701-724, Korea Tel: 82-53-940-7545, Fax: 82-53-954-7417 E-mail: mjmom99@naver.com

∗This study was presented as a narration at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 13 December 20143 February 2015 Accepted 26 May 2015

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 and risk factors of hemorrhagic complications in polypoidal choroidal vasculopathy (PCV) using spectral domain-optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA).

Methods:

We respectively reviewed the data from 43 patients (45 eyes) diagnosed with PCV who received ICGA between January 2010 and October 2013. The patients were divided into 2 groups: 16 patients (17 eyes) with subretinal hemorrhage (su-bretinal hemorrhagic PCV group) and 27 patients (28 eyes) without subretinal hemorrhage (control group). Based on the ICGA and SD-OCT findings, the number, morphology, location, size of polyps, pigment epithelial detachment (PED), and serous reti-nal detachment (SRD) were measured and compared between the 2 groups. We also analyzed systemic diseases and history of antithrombotic agents associated with subretinal hemorrhage in PCV.

Results:

The size of polyps measured by ICGA was significantly different between the 2 groups ( p = 0.006). As the size of polyps increased, the size of subretinal hemorrhage, height of PED, base diameter and height of SRD increased ( p < 0.05). No stat-istical correlation with systemic diseases and antithrombotic agents was observed ( p > 0.05).

Conclusions:

The patients in the subretinal hemorrhagic PCV group had larger-sized polyps than the patients in the control group. This result suggests that eyes with larger-sized polyps are at risk for hemorrhagic complications and require more careful follow-up and observation in PCV treatment-naïve patients.

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Keywords: Indocyanine green angiography, Polypoidal choroidal vasculopathy, Size of polyps, Spectral domain-optical coher-ence tomography, Subretinal hemorrhage

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Figure 1.

60 year old man (A-C) and 84 years old man (D-F) with massive subretinal hemorrhage in a polypoidal choroidal vasculopathy. (A, D) Color fundus photograph showing orange-red polypoidal region with massive subretinal hemorrhage. (B, E) Indocyanine green angiography showing a polypoidal macular consistent with the orange-red nodules seen on fundus photography. (C, F) Spectral domain-optical coherence tomography showing a dome like elevation of highly reflective band corresponding to the detached retina pigment epithelium.

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Figure 2.

(A) Indocyanine green angiography findings showing dense clusters of numerous, small, hyperfluorescent dots resembling microaneurysmal dilatations (arrow). (B) Relatively large aneurismal dilations (arrow). (C) Atypical vessel deformations, loop like configurations or dilations (arrow) in polypoidal choroidal vasculopathy.

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Figure 3.

The distribution of polyp size of study group. SubR Hm = subretinal hemorrhage.

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Table 1.

Demographics and clinical information of the study group

Parameter	Group (%)		Total (%)	p-value
Parameter	Subretinal hemorrhagic PCV	Non-subretinal hemorrhagic PCV	Total (%)	p-value
Number of patients	16	27	43
Number of eyes	17	28	45
Mean age (years)	69.7 ± 2.1	62.1 ± 3.6	64.9 ± 2.4
Gender (%)
Male	12 (75)	19 (70.4)	31 (72.1)
Female	4 (25)	8 (29.6)	12 (27.9)
Right:left (eyes)	5:12	17:11	22:27
BCVA (log MAR)	0.85 ± 0.15	0.59 ± 0.09	0.69 ± 0.08	0.127^†
Underlying disease (%)
Hypertension	9 (56.3)	11 (40.7)	21 (48.8)	0.361^∗
DM	3 (18.8)	5 (18.5)	8 (18.6)	1.000^∗
Heart attack/CVA	4 (25.0)	3 (11.1)	7 (16.2)	0.394^∗
Cancer	2 (12.5)	1 (3.7)	3 (6.9)	0.545^∗
Anticoagulant	4 (25.0)	2 (7.4)	6 (13.9)	0.174^∗

Values are presented as mean ± SD unless otherwise indicated.

PCV = polypoidal choroidal vasculopathy; BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; DM = diabetes mellitus; CVA = cardio-vascular attack.

^∗ Fisher’s exact test;

^† Mann-Whitney U-test.

Table 2.

Comparison of ICGA findings between subretinal hemorrhage group and control group

	Subretinal hemorrhagic PCV (n = 17)	Non-subretinal hemorrhagic PCV (n = 28)	Total (n = 45)	p-value
Polyps location				0.535^∗
Subfovea	8 (47.1)	11 (39.3)	19 (42.2)
Juxtafovea	3 (17.6)	10 (35.7)	13 (28.9)
Extrafovea	6 (35.3)	7 (25.0)	13 (28.9)
Number of polyps				0.414^∗
n ≤ 2	7 (41.2)	8 (28.6)	15 (33.3)
3 ≤ n < 5	2 (11.8)	8 (28.6)	10 (22.2)
n ≥ 5	8 (47.1)	12 (42.9)	20 (44.4)
Polyps morphology				0.744^∗
Cluster, microaneurysm	8 (47.1)	17 (60.7)	25 (55.6)
Dilated, macroaneurysm	7 (41.2)	8 (28.6)	15 (33.3)
Vessel malformation	2 (11.8)	3 (10.7)	5 (11.1)
Polyps size (μ m)	178 ± 16	121 ± 9	142 ± 9	0.006^†
≤150	7 (41.2)	21 (75)	28 (62.2)
151-250	7 (41.2)	7 (25)	14 (31.1)
>250	3 (17.6)	0 (0)	3 (6.7)

Values are presented as mean ± SD or n (%). ICGA = indocyanine green angiography; PCV = polypoidal choroidal vasculopathy.

^∗ Fisher’s exact test,

^† Mann-Whitney U-test.

Table 3.

Comparison of SD-OCT findings between subretinal hemorrhage group and control group

	Subretinal hemorrhagic PCV	Non-subretinal hemorrhagic PCV	Total	p-value^∗
PED base (μ m)	2,815 ± 424	1,164 ± 137	1,765 ± 212	p < 0.001
PED height (μ m)	657 ± 93	171 ± 17	347 ± 50	p < 0.001
SRD base (μ m)	3,762 ± 571	1,940 ± 272	2,630 ± 298	0.004
SRD height (μ m)	437 ± 78	118 ± 19	234 ± 38	p < 0.001

Values are presented as mean ± SD.

SD-OCT = spectral domain-optical coherence tomography; PCV = polypoidal choroidal vasculopathy; PED = pigment epithelial detachment; SRD = serous retinal detachment.

^∗ Mann-Whitney U-test.

Table 4.

Relationship between the size of polyps, subretinal hemorrhage, PED and SRD measured by ICGA and SD-OCT

	Polyps size (μ m)
	r	p-value^∗
Subretinal hemorrhage size	0.616	0.008
PED base	0.202	0.189
PED height	0.399	0.007
SRD base	0.404	0.007
SRD height	0.466	0.001

PED = pigment epithelial detachment; SRD = serous retinal detachment; ICGA = indocyanine green angiography; SD-OCT= spectral domain-optical coherence tomography.

^∗ Spearman correlation.

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