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Cho, Joon Hee, MD*,†; Park, Young Joo, MD*; Cho, Soo Chang, MD*,‡; Ryoo, Na-Kyung, MD*,§; Cho, Kwan Hyuk, MD*,¶; Park, Sang Jun, MD, MSc*; Park, Kyu Hyung, MD, PhD*; Woo, Se Joon, MD, PhD*

doi: 10.1097/IAE.0000000000002384
Original Study: PDF Only

Purpose: To study the association between the risk of massive submacular hemorrhage (SMH) and polyp regression after initial treatment of polypoidal choroidal vasculopathy using long-term follow-up data.

Methods: Retrospective study of 223 patients who were diagnosed with polypoidal choroidal vasculopathy and were followed up for up to 11 years. Subjects were categorized into “regression” and “no regression” groups, according to their polyp status after the initial treatment. Kaplan–Meier survival analyses were performed on development of massive SMH. The association between treatment methods and the occurrence of massive SMH was also analyzed.

Results: The incidence rates of massive SMH at 3, 6, and 9 years in the “no regression” group were 6.50, 22.59, and 38.03%, respectively, and in the “regression” group were 1.14, 6.47, and 10.92%, respectively (P = 0.005, log-rank test). The hazard ratio of massive SMH was 3.677 for cluster-type polyps and 0.271 for polyp regression after initial treatment. A higher rate of polyp regression was associated with photodynamic therapy (PDT) than anti-VEGF monotherapy (64.4 vs. 33.3%, P < 0.001). Additional anti-VEGF treatments after initial PDT showed lower risk of massive SMH than PDT only. (9.5 vs 38.5%, P = 0.005).

Conclusion: The long-term risk of massive SMH after initial treatment on polypoidal choroidal vasculopathy is significantly higher in eyes with persistent polyps than those with regressed polyps. Ophthalmologists should pay attention to the risk of massive SMH and the polyp status when treating polypoidal choroidal vasculopathy.

The long-term risk of massive submacular hemorrhage in eyes with polypoidal choroidal vasculopathy can be reduced if the polyps are regressed, which was associated with treatment methods.

*Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea;

Hyemin Eye Hospital, Seoul, South Korea;

Department of Ophthalmology, Kyungpook National University Hospital, Daegu, South Korea;

§Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, South Korea; and

Moon's Eye Clinic, Suwon, South Korea.

Reprint requests: Se Joon Woo, MD, PhD, Department of Ophthalmology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; e-mail:

Supported by the National Research Foundation of Korea (NRF) grant (2016R1D1A1B03934724) funded by the Korean government (MSIP).

None of the authors has any conflicts of interest to disclose.

The funding organization had no role in the design or conduct of this research.

© 2018 by Ophthalmic Communications Society, Inc.