Abstract
Purpose
To report the outcomes of pars plana vitrectomy in cases with breakthrough vitreous hemorrhage (VH) secondary to exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy. We also investigated the relationship between the preoperative b-mode ultrasonographic findings and the postoperative visual acuity to determine if the ultrasonographic findings can predict the surgical outcome after pars plana vitrectomy.
Methods
This was a retrospective, interventional, case series. Twenty eyes of 20 patients were studied. The associations between the pre- and intraoperative factors and the final best-corrected visual acuity (BCVA) were determined. Recombinant tissue-plasminogen activator (tPA) was used in cases with massive hemorrhagic retinal detachment.
Results
Ten eyes with polypoidal choroidal vasculopathy (PCV), two eyes with choroidal neovascularization (CNV), and eight eyes with an unknown type of AMD were studied. The mean BCVA was 0.73 ± 0.57 logarithm of the minimum angle of resolution (logMAR) units before developing the VH, 2.25 ± 0.45 logMAR units before the surgery, and 1.52 ± 0.87 logMAR units after the surgery. The BCVA improved significantly after the surgery (P = 0.004) but was significantly worse than that before developing the VH (P = 0.012). The cases of PCV had better final BCVA than cases of CNV (P = 0.043, Mann–Whitney test). The preoperative presence of a subretinal elevation at the macula detected by ultrasonography was significantly associated with a poorer final BCVA (P = 0.031).
Conclusions
Vitrectomy significantly improved visual function in the eyes with VH associated with exudative AMD. The eyes with PCV and no macular subretinal elevation on ultrasonography had a better visual prognosis.
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Data availability
Data used in this study are available upon requests.
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Acknowledgements
The authors indicate no financial support or financial conflict of interest involved in the design and conduct of the study, the collection of data, management, analysis and interpretation of data, and preparation, review, or approval of the manuscript. The authors thank Professor Emeritus Duco Hamasaki of the Bascom Palmer Eye Institute of the University of Miami for his critical discussion and editing final manuscript.
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The authors received no financial support for the research, authorship, and/or publication of this article.
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TB and TI contributed to conception and design; TI, YS, and TB contributed to data collection; TB, TN, HY, MK-T, MK, and SY contributed to analysis and interpretation; TB, TI, YS, TN, HY, MK-T, MK, and SY took overall responsibility.
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This study was approved by the Institutional Review Board of Chiba University Graduate School of Medicine (No.3826), and the procedures conformed to the tenets of the Declaration of Helsinki. The procedures to be used and the purpose of this study were transmitted to the patients through the Internet, and the patients were eligible to opt out from the study. The collection of data was conducted based on the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.
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This was a retrospective study and was not registered as a clinical trial.
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Iwase, T., Baba, T., Saito, Y. et al. Surgical outcomes of vitrectomy for breakthrough vitreous hemorrhage in eyes with exudative age-related macular degeneration. Int Ophthalmol (2021). https://doi.org/10.1007/s10792-021-01744-x
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Keywords
- Exudative age-related macular degeneration
- Vitreous hemorrhage
- Vitrectomy
- Visual acuity
- Ultrasonography