Minimally Invasive Surgical Treatment of Macular Hemorrhages

Hattenbach, Lars‐Olof

doi:10.1007/978-3-319-65877-3_5

Cited by 1 publication

(6 citation statements)

References 45 publications

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“…The OCT findings seemed helpful when differentiating between nAMD and RAM in eyes with SMH. In agreement with previous reports, the current study showed that eyes with RAM were most likely to have hemorrhage involving more than two layers including the sub-hyaloidal/sub-ILM space and no sub-RPE hemorrhage, whereas eyes with nAMD were more likely to have subretinal and sub-RPE hemorrhage and no preretinal hemorrhage [ 1 , 19 ].…”

Section: Discussionsupporting

confidence: 92%

“…A previous study showed that the visual prognosis of nAMD-related SMH is worse than that of RAM [ 1 ]. The current study revealed that the BCVA of PCV was significantly better than that in the other groups throughout the study period, whereas the BCVA of tnAMD did not improve significantly from baseline to final visit.…”

Section: Discussionmentioning

confidence: 99%

“…The characteristics of SMH were classified using the FLATCAPS (Foveal Involvement, Retinal Layers, Age/Duration, Thickness, Cause/Pathogenesis, Size) system [ 1 ]. Because this study included eyes with SMH involving the fovea, the other items in the classification system (retinal layers, age/duration, thickness, cause, and size) were investigated.…”

Section: Methodsmentioning

confidence: 99%

“…Optical coherence tomography (OCT) enables the depiction of the detailed distribution of hemorrhage in various layers, such as the preretinal (subhyaloid or sub-internal limiting membrane), intraretinal, subretinal, and subretinal pigment epithelium (sub-RPE). A classification of SMH recently proposed by researchers from Europe termed FLATCAPS includes the etiology, location, and size of hemorrhage based on fundus photographs and OCT findings [ 1 ]. Using this classification system, we attempted to differentiate SMH in a large number of Japanese patients.…”

Section: Introductionmentioning

confidence: 99%

“…When untreated, it causes irreversible damage to photoreceptors, resulting in significant visual deterioration. Neovascular age-related macular degeneration (nAMD) and retinal arterial macroaneurysm (RAM) are two major causes of SMH [ 1 – 3 ]. In Asia, polypoidal choroidal vasculopathy (PCV), which is a subtype of nAMD characterized by polyp-like choroidal vascular dilation, is frequently associated with SMH [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Differences in clinical characteristics and treatment outcomes of submacular hemorrhage caused by age-related macular degeneration and retinal macroaneurysms: A multicenter survey from the Japan Clinical Retina Study (J-CREST) group

Kimura

Araki²,

Yasukawa³

et al. 2022

PLoS ONE

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Purpose To evaluate the clinical characteristics, treatment trends, and visual prognosis of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD) and retinal arterial macroaneurysm (RAM). Methods This retrospective study enrolled 187 Japanese patients with SMH at 10 institutions from 2015 to 2018. Medical records including SMH etiology, best-corrected visual acuity (BCVA), fundus photographs, optical coherence tomography images, and selected treatments were analyzed. Results Major causes of SMH were typical nAMD (tnAMD) (18%), polypoidal choroidal vasculopathy (PCV) (50%) and RAM (29%). Age, male/female ratio, baseline BCVA, central retinal thickness, and involved retinal layers were significantly different between etiologies (all P<0.0001). Treatment with anti-vascular endothelial growth factor drugs with and without intravitreal gas injection was chosen for half of eyes in the tnAMD and PCV groups, whereas vitrectomy was performed in 83.7% of eyes with RAM. The final BCVA improved significantly from baseline in the PCV and RAM groups (P = 0.0009, P<0.0001) and final BCVA was significantly better in the PCV group at a level similar to the other groups (P = 0.0007, P = 0.0008). BCVA improvement from baseline was significantly greater in the RAM group compared with the tnAMD (P = 0.0152) and PCV (P = 0.017) groups. Multivariate analysis revealed better final BCVA was significantly associated with younger age (P = 0.0054), better baseline BCVA (P = 0.0021), RAM subtype (P = 0.0446), and no tnAMD (P = 0.001). Conclusions The characteristics of, and treatment strategy for, SMH were different between the underlying diseases. Anti-vascular endothelial growth factor treatment with or without expansile gas was mainly chosen for SMH in tnAMD and PCV, whereas vitrectomy with gas was the most common treatment for RAM, and the higher rate for vitrectomy might result in the greater BCVA improvement in the RAM group than in the other groups. Final BCVA was better in PCV, RAM, and tnAMD, in that order, because patients with PCV were younger and had better baseline BCVA.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%