Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Sci Rep. 2018 Jul 12;8(1):10560. doi: 10.1038/s41598-018-28938-1.
To investigate the risk factors for breakthrough vitreous hemorrhage (VH) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in age-related macular degeneration (AMD) accompanied by submacular hemorrhage (SMH). We retrospectively reviewed the medical records of patients diagnosed with AMD combined with SMH, and enrolled 31 patients. We formed an age- and sex-matched control group of patients with submacular hemorrhage who did not develop breakthrough VH after intravitreal injection during 6 month follow-up. The mean patient age was 70.8 ± 10.3 years in the breakthrough VH group. Of the 31 patients, 8 were diagnosed with choroidal neovascularization (CNV), 22 with polypoidal choroidal vasculopathy (PCV), and 1 with retinal angiomatous proliferation (RAP). PCV was associated with a significantly higher incidence of VH (odds ratio, 35.01; p = 0.001). The size of the SMH was 22.7 ± 12.4 disc areas (DAs) in the breakthrough VH group and 5.4 ± 6.9 DAs in the control group, and was thus significantly related to the development of VH (p < 0.001). The risk of VH was significantly higher in those taking anticoagulants (p = 0.014). There was no significant difference between the types of anti-VEGF agents. When taking anticoagulant medications, a SMH of large diameter, and PCV subtype were risk factors for breakthrough VH after anti-VEGF injection.
探讨年龄相关性黄斑变性（AMD）伴脉络膜下出血（SMH）患者经玻璃体腔内抗血管内皮生长因子（anti-VEGF）注射后发生玻璃体积血（VH）突破的危险因素。我们回顾性分析了诊断为 AMD 合并 SMH 的患者的病历，并纳入 31 例患者。我们将 6 个月随访期间未发生玻璃体内注射后 VH 突破的 SMH 患者作为年龄和性别匹配的对照组。突破 VH 组患者的平均年龄为 70.8±10.3 岁。31 例患者中，8 例为脉络膜新生血管（CNV），22 例为息肉样脉络膜血管病变（PCV），1 例为视网膜血管性增殖（RAP）。PCV 与 VH 发生率显著升高相关（比值比，35.01；p=0.001）。突破 VH 组的 SMH 大小为 22.7±12.4 个视盘面积（DA），对照组为 5.4±6.9 DA，两组差异有统计学意义（p<0.001）。SMH 较大且服用抗凝药物是 VH 发生的显著危险因素（p=0.014）。抗 VEGF 药物类型之间无显著差异。当服用抗凝药物时，SMH 直径大、PCV 亚型是抗 VEGF 注射后 VH 突破的危险因素。
