Department of Ophthalmology, Kosin University Hospital, Busan, South Korea.
Department of Ophthalmology, College of Medicine, Gyeonsang National University, Jinju, South Korea.
PLoS One. 2020 Dec 3;15(12):e0243201. doi: 10.1371/journal.pone.0243201. eCollection 2020.
We investigated risk factors for breakthrough vitreous hemorrhage (VH) after an intravitreal tissue plasminogen activator (tPA) and gas injection in patients with submacular hemorrhage (SMH) associated with age-related macular degeneration (AMD).
The medical records of patients diagnosed with SMH associated with AMD who received an intravitreal tPA (50 μg/0.05 mL) and perfluoropropane gas (0.3 mL) injection were reviewed retrospectively. We analyzed the associations of breakthrough VH with age, sex, best-corrected visual acuity, intraocular pressure, AMD subtype, accompanying sub-retinal pigment epithelium (RPE) hemorrhage, history of cataract surgery, history of hypertension and diabetes mellitus, history of drinking and smoking, and history of antiplatelet or anticoagulant medication. We also examined the relationships between various parameters, including the area ratio of the SMH to the optic disc (AHD) and the height of the SMH obtained from optical coherence tomography.
In total, 52 eyes from 52 patients were enrolled in this study; 16 eyes (30%) showed breakthrough VH. The proportions of patients with a current smoking history were 75.0% in the VH group and 22.2% in the non-VH group (p = 0.010). Other factors did not differ significantly between the two groups. The proportion of cases with accompanying sub-RPE hemorrhage was 50.0% and 58.3% in the VH and non-VH groups, respectively (p = 0.763). The AHD (p = 0.001) and SMH height (p < 0.001) were significantly greater in the VH group. In a receiver operating characteristic curve analysis, the cut-off values of AHD and SMH height were 20.1 and 1208 μm, respectively. According to logistic regression analysis, when the AHD and SMH height were greater than the individual cut-off values, the odds ratio of VH increased by 10.286 fold (95% confidence interval [CI], 2.452-43.148; p = 0.001) and 75.400 fold (95% CI, 7.991-711.441; p < 0.001), respectively, with respect to their respective reference groups (less than the cut-off value). Among the significant factors associated with VH occurrence, including current smoking, AHD, and SMH height, only current smoking and SMH height were found to be significant in multiple regression analysis (p = 0.040, 0.016).
The incidence of breakthrough VH was significantly higher in those with current smoking status and for SMH with a larger AHD and greater height. The height of the SMH was more predictable of the possibility of VH than AHD.
我们研究了与年龄相关性黄斑变性（AMD）相关的黄斑下出血（SMH）患者接受玻璃体内组织纤溶酶原激活物（tPA）和气体注射后玻璃体积血（VH）突破的危险因素。
回顾性分析了接受玻璃体内 tPA（50μg/0.05mL）和全氟丙烷气体（0.3mL）注射治疗的 SMH 合并 AMD 患者的病历。我们分析了 VH 与年龄、性别、最佳矫正视力、眼内压、AMD 亚型、伴视网膜下色素上皮（RPE）出血、白内障手术史、高血压和糖尿病史、饮酒和吸烟史以及抗血小板或抗凝药物史的关系。我们还检查了各种参数之间的关系，包括从光学相干断层扫描获得的 SMH 与视盘的面积比（AHD）和 SMH 的高度。
本研究共纳入 52 例 52 只眼；16 只眼（30%）出现 VH 突破。有当前吸烟史的患者比例分别为 VH 组的 75.0%和非 VH 组的 22.2%（p=0.010）。两组其他因素无显著差异。VH 组和非 VH 组伴有视网膜下 RPE 出血的比例分别为 50.0%和 58.3%（p=0.763）。VH 组的 AHD（p=0.001）和 SMH 高度（p<0.001）明显较大。在受试者工作特征曲线分析中，AHD 和 SMH 高度的截断值分别为 20.1 和 1208μm。根据逻辑回归分析，当 AHD 和 SMH 高度大于各自的截断值时，VH 的优势比分别增加 10.286 倍（95%置信区间[CI]：2.452-43.148；p=0.001）和 75.400 倍（95%CI：7.991-711.441；p<0.001），与各自的参考组（低于截断值）相比。在与 VH 发生相关的显著因素中，包括当前吸烟、AHD 和 SMH 高度，仅当前吸烟和 SMH 高度在多因素回归分析中被发现具有统计学意义（p=0.040，0.016）。
当前吸烟状态和 AHD 较大、SMH 高度较高的患者 VH 发生率显著较高。SMH 的高度比 AHD 更能预测 VH 的可能性。
