Kritfuangfoo Thanaporn, Li Yanliang, Mieler William F
Department of Ophthalmology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL, USA.
Clin Ophthalmol. 2025 Aug 19;19:2821-2833. doi: 10.2147/OPTH.S535257. eCollection 2025.
To evaluate the clinical characteristics and treatment outcomes of breakthrough vitreous hemorrhage secondary to peripheral exudative hemorrhagic chorioretinopathy (PEHCR).
This retrospective study included 14 eyes from 14 patients with vitreous hemorrhage secondary to peripheral retinochoroidal mass lesions. Data collected included demographic profiles, clinical presentation, multimodal imaging findings, and treatment outcomes following pars plana vitrectomy (PPV), intravitreal anti-VEGF injections, or laser photocoagulation.
The median age at presentation was 83 years (range, 58-91), with nine females (64.3%). Median presenting visual acuity (VA) was 1.3 logMAR (range, 0.3-2.7). All patients had normal intraocular pressure. Bilateral PEHCR was observed in 50%, though hemorrhage occurred unilaterally. Unifocal lesions were present in 71.4%, with a mean lesion thickness of 3.4 mm (range, 1.5-6.8 mm). Dense vitreous hemorrhage obscuring posterior pole details was seen in eight eyes (57.1%) and required PPV. The remaining six eyes, with moderate hemorrhage, improved spontaneously without surgery. Intravitreal anti-VEGF therapy was administered in five eyes for macular involvement or to prevent recurrent hemorrhage. At a median follow-up of 11.7 months (range, 3-63), median VA improved to 0.36 logMAR (range, 0.1-2.0). The mean VA gain was 0.76 logMAR in the vitrectomy group (p = 0.004) and 0.55 logMAR in eyes without macular involvement (p = 0.024). However, five eyes (35.7%) had final VA ≤ 20/200 due to macular pathology consistent with age-related macular degeneration or polypoidal choroidal vasculopathy-like changes.
PEHCR with breakthrough vitreous hemorrhage is a rare but important diagnostic consideration in patients presenting with peripheral retinochoroidal mass-like lesions. PPV and intravitreal anti-VEGF therapy may improve visual outcomes in these cases. However, visual recovery may be limited in cases with macular involvement due to irreversible retinal damage. Early diagnosis and tailored management are essential to optimize outcomes and avoid misdiagnosis.
评估周边渗出性出血性脉络膜视网膜病变（PEHCR）继发的玻璃体出血突破的临床特征和治疗效果。
这项回顾性研究纳入了14例周边视网膜脉络膜肿块病变继发玻璃体出血患者的14只眼。收集的数据包括人口统计学资料、临床表现、多模态影像学检查结果以及玻璃体切割术（PPV）、玻璃体内抗VEGF注射或激光光凝后的治疗效果。
就诊时的中位年龄为83岁（范围58 - 91岁），女性9例（64.3%）。就诊时的中位视力（VA）为1.3 logMAR（范围0.3 - 2.7）。所有患者眼压正常。50%观察到双侧PEHCR，尽管出血为单侧发生。71.4%存在单灶性病变，平均病变厚度为3.4 mm（范围1.5 - 6.8 mm）。8只眼（57.1%）出现致密玻璃体出血，遮挡了后极部细节，需要进行PPV。其余6只眼出血程度中等，未经手术自发改善。5只眼因黄斑受累或预防反复出血接受了玻璃体内抗VEGF治疗。中位随访11.7个月（范围3 - 63个月）时，中位VA改善至0.36 logMAR（范围0.1 - 2.0）。玻璃体切割术组的平均VA提高值为0.76 logMAR（p = 0.004），未累及黄斑的眼为0.55 logMAR（p = 0.024）。然而，5只眼（35.7%）最终视力≤20/200，原因是黄斑病变符合年龄相关性黄斑变性或息肉样脉络膜血管病变样改变。
PEHCR伴玻璃体出血突破是出现周边视网膜脉络膜肿块样病变患者中一种罕见但重要的诊断考虑因素。PPV和玻璃体内抗VEGF治疗可能改善这些病例的视力结果。然而，由于不可逆的视网膜损伤，黄斑受累病例的视力恢复可能有限。早期诊断和针对性管理对于优化治疗结果和避免误诊至关重要。
