Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Ophthalmology, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
Acta Ophthalmol. 2021 Aug;99(5):e706-e714. doi: 10.1111/aos.14676. Epub 2020 Dec 2.
To investigate the incidence rate of massive submacular haemorrhage (SMH) and risk factors in polypoidal choroidal vasculopathy (PCV) and typical neovascular age-related macular degeneration (tnAMD).
A total of 465 patients who were diagnosed with either PCV (n = 245) or tnAMD (n = 220) from 2003 to 2014 were enrolled. Cumulative incidence of massive SMH in PCV and that in tnAMD were compared. Risk factors of massive SMH were also analysed.
Massive SMH occurred in 32 patients (13.1%) with PCV and 9 patients (4.1%) with tnAMD. Incidence rates of massive SMH 5 and 10 years after the first visit were 11.1% and 29.9% in PCV and 4.3% and 9.9% in tnAMD, respectively. Incidence rates of massive SMH in PCV were significantly higher than those in tnAMD (hazard ratio [HR], 2.66; p = 0.007). Cox regression analysis revealed that mean number of photodynamic therapies (PDTs) per year (HR, 4.24; p < 0.001), cluster type of polypoidal lesion (HR, 3.42; p = 0.003) in PCV, and mean number of anti-VEGF injections per year (HR, 1.58; p < 0.001) in tnAMD were significantly associated with risk of massive SMH. For patients with severe vision loss, proportion of incident massive SMH was significantly higher in PCV (29.5%) than in tnAMD (6.9%, p < 0.001).
The incidence rate of massive SMH in eyes with PCV was about three times higher than that in eyes with tnAMD. Treatment methods that can reduce the incidence of massive SMH should be considered, especially for eyes with PCV.
探讨息肉样脉络膜血管病变（PCV）和典型新生血管性年龄相关性黄斑变性（tnAMD）患者发生大量黄斑下出血（SMH）的发生率及相关危险因素。
共纳入 2003 年至 2014 年间确诊为 PCV（n=245）或 tnAMD（n=220）的 465 例患者。比较 PCV 和 tnAMD 患者大量 SMH 的累积发生率。同时分析大量 SMH 的危险因素。
32 例（13.1%）PCV 患者和 9 例（4.1%）tnAMD 患者发生大量 SMH。PCV 患者首次就诊后 5 年和 10 年发生大量 SMH 的发生率分别为 11.1%和 29.9%，tnAMD 患者分别为 4.3%和 9.9%。PCV 患者大量 SMH 的发生率明显高于 tnAMD（风险比[HR]，2.66；p=0.007）。Cox 回归分析显示，PCV 患者每年平均光动力疗法（PDT）次数（HR，4.24；p<0.001）、息肉样病变的簇状类型（HR，3.42；p=0.003）和 tnAMD 患者每年平均抗血管内皮生长因子（VEGF）注射次数（HR，1.58；p<0.001）与大量 SMH 的发生风险显著相关。对于视力严重丧失的患者，PCV 中大量 SMH 的发生率（29.5%）明显高于 tnAMD（6.9%，p<0.001）。
PCV 眼发生大量 SMH 的发生率约为 tnAMD 眼的 3 倍。应考虑采用能降低大量 SMH 发生率的治疗方法，特别是针对 PCV 眼。
