为了评估临床特征,治疗趋势,和视力预后继发于新生血管性年龄相关性黄斑变性(nAMD)和视网膜动脉大动脉瘤(RAM)的黄斑下出血(SMH)。
这项回顾性研究纳入了2015年至2018年10个机构的187名日本SMH患者。医疗记录包括SMH病因,最佳矫正视力(BCVA),眼底照片,光学相干层析成像图像,并对选定的治疗方法进行分析。
SMH的主要原因是典型的nAMD(tnAMD)(18%),息肉状脉络膜血管病变(PCV)(50%)和RAM(29%)。年龄,男性/女性比例,基线BCVA,中央视网膜厚度,和受累的视网膜层在病因之间存在显着差异(所有P<0.0001)。在tnAMD和PCV组中,选择了有或没有玻璃体内气体注射的抗血管内皮生长因子药物治疗,而83.7%的RAM眼进行了玻璃体切除术。PCV和RAM组的最终BCVA比基线显着改善(P=0.0009,P<0.0001),PCV组的最终BCVA明显更好,水平与其他组相似(P=0.0007,P=0.0008)。与tnAMD(P=0.0152)和PCV(P=0.017)组相比,RAM组的BCVA相对于基线的改善明显更大。多因素分析显示,较好的最终BCVA与年龄较小显著相关(P=0.0054)。更好的基线BCVA(P=0.0021),RAM亚型(P=0.0446),无tnAMD(P=0.001)。
的特点,和治疗策略,SMH在基础疾病之间是不同的。在tnAMD和PCV中,SMH主要选择有或没有膨胀性气体的抗血管内皮生长因子治疗,而玻璃体切除术与气体是最常见的治疗RAM,较高的玻璃体切除术率可能导致RAM组的BCVA改善大于其他组。最终BCVA在PCV中更好,RAM,和tnAMD,按照这个顺序,因为PCV患者较年轻,基线BCVA较好.
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).
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.
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).
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.