Ultrasonographic Characteristics and Treatment Outcomes of Surgery for Vitreous Hemorrhage in Idiopathic Polypoidal Choroidal Vasculopathy

Abstract

To describe the ultrasonographic characteristics and treatment outcomes of surgery in vitreous hemorrhage (VH) associated with idiopathic polypoidal choroidal vasculopathy (IPCV). Retrospective interventional and observational case series. Clinical, ultrasound, and surgical data of 10 consecutive patients operated for VH due to IPCV in a tertiary eye institute was studied by chart review. Data were analyzed to determine the clinical features, ultrasonographic characteristics, and surgical outcomes. An additional five patients with IPCV without VH were evaluated by ultrasound in various stages of the disease. Between January 1998 and March 2005, 10 eyes of 10 patients underwent vitreous surgery for VH associated with IPCV. Characteristic ultrasonographic features that helped the diagnosis preoperatively included focal choroidal thickening without excavation or acoustic hollowing with associated low reflective echoes of dispersed VH, or diffuse choroidal thickening and low-intensity echoes of dispersed hemorrhage on either side of the retinal spike, often without vitreous detachment spike. Oral corticosteroids were provided preoperatively to patients with associated exudative retinal detachment. Indocyanine green angiography (ICGA) confirmed IPCV postoperatively. Focal lesions were treated with laser photocoagulation. Anatomical success was seen in nine of 10 eyes. Visual acuity improved in five of 10 eyes but was limited by macular pathology in other five eyes. The most common complication was iatrogenic tears. Some eyes had recurrent IPCV lesions in follow-up. Characteristic ultrasonographic features could identify IPCV in eyes with VH. Anatomical and visual outcomes of our management approach were encouraging and need further study.