Lam Sophia S, Shahlaee Abtin, Salabati Mirataollah, Klufas Michael A
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Philadelphia, PA, USA.
J Vitreoretin Dis. 2023 Oct 3;7(6):483-489. doi: 10.1177/24741264231200734. eCollection 2023 Nov-Dec.
To evaluate the clinical outcomes of different types of treatment of retinal arterial macroaneurysm with vitreous hemorrhage. This retrospective cohort study comprised patients with retinal arterial macroaneurysm and vitreous hemorrhage who were examined at a single retina clinic between 2013 and 2021. Treatment arms included observation (n = 33), intravitreal injections (IVIs) of antivascular endothelial growth factor agents (n = 5), and pars plana vitrectomy (PPV; n = 12). Baseline characteristics and final best-corrected visual acuity (BCVA) were similar in a combined analysis of all treatment groups ( > .05). The BCVA improved in all eyes, but the IVI and PPV arms had worse presenting BCVA. The mean number of injections was 3.6 ± 2.8. The incidence of subretinal hemorrhage was 18.2% in the observation arm, 25.0% in the PPV group (8.3% had subretinal tissue plasminogen activator), and 60.0% in the IVI group. The mean time to intervention was 13 ± 15.3 days for PPV and 38 ± 69.9 days for IVI. There was no correlation between the number of injections and the final BCVA ( = 0.13, = .830). The IVI and PPV arms were more frequently on anticoagulants ( = .011). There was no difference in final BCVA between those using anticoagulants (0.52 ± 0.53) vs not using anticoagulants (0.55 ± 0.65) ( = .870). Most patients, regardless of treatment modality, demonstrated significantly improved BCVA and similar final visual outcomes. Patients with worse presenting BCVA were more likely to undergo PPV or IVI whereas those with better presenting BCVA had excellent outcomes with observation alone. Improved BCVA was not associated with the number of IVIs or anticoagulant use.
评估视网膜动脉大动脉瘤合并玻璃体积血不同治疗方式的临床疗效。这项回顾性队列研究纳入了2013年至2021年间在一家视网膜诊所接受检查的视网膜动脉大动脉瘤合并玻璃体积血患者。治疗组包括观察（n = 33）、玻璃体内注射抗血管内皮生长因子药物（IVI，n = 5）和平坦部玻璃体切除术（PPV，n = 12）。在对所有治疗组的综合分析中，基线特征和最终最佳矫正视力（BCVA）相似（P>0.05）。所有患眼的BCVA均有所改善，但IVI组和PPV组的初始BCVA较差。平均注射次数为3.6±2.8次。观察组视网膜下出血发生率为18.2%，PPV组为25.0%（8.3%使用视网膜下组织纤溶酶原激活剂），IVI组为60.0%。PPV的平均干预时间为13±15.3天，IVI为38±69.9天。注射次数与最终BCVA之间无相关性（r = 0.13，P = 0.830）。IVI组和PPV组使用抗凝剂的频率更高（P = 0.011）。使用抗凝剂者（0.52±0.53）与未使用抗凝剂者（0.55±0.65）的最终BCVA无差异（P = 0.870）。无论治疗方式如何，大多数患者的BCVA均显著改善，最终视力结果相似。初始BCVA较差的患者更有可能接受PPV或IVI治疗，而初始BCVA较好的患者仅通过观察即可获得良好结果。BCVA的改善与IVI次数或抗凝剂使用无关。
