Trea tment of polypoid choroidal vasculopathy complicated by extensive subretinal hemorrhage. A case report

Abstract

Polypoid choroidal vasculopathy (PCV) is a type of wet form of age-related macular degeneration (AMD). It is characterized by formation aneurysmal dilations of abnormal choroidal vessels (polyps) under the retinal pigment epithelium (RPE) in the choroid. The disease leads to a vision loss due to formation of serous retinal detachment, neuroepithelium detachment and RPE, subretinal hemorrhages, fibrosis, atrophy of RPE. The generally accepted treatment of PCV is antiangiogenic therapy.The purpose of this work is to present and to analyze the clinical case of polypoid choroidal vasculopathy treatment complicated by extensive subretinal hemorrhage.Description of the case. This clinical case of PCV in the right eye that is complicated by extensive subretinal hemorrhage on the background of antiangiogenic therapy in a 72-year-old man is presented. In addition to standard ophthalmological research methods, we performed optical coherence tomography (OCT) with Cirrus HD-OCT 5000 Zeiss (Carl Zeiss, Germany), angio-OCT with Optovue Solix High-Speed Spectral Optical Coherence Tomograph (Optovue, USA) and fundus photo registration with Topcon TRC-NW8F Retinal Camera (Topcon, Japan). The comprehensive surgical approach was applied to this patient, including posterior subtotal vitrectomy with our Stellaris PC microsurgical system (Baush&Lomb, USA) and the prourokinase subretinal injection against the background of aflibercept antiangiogenic therapy and removal of a concomitant cataract with implantation of an intraocular lens (IOL).Discussion. The early treatment of this patient and at the right time procedure of microinvasive 25-G vitrectomy combined with prourokinase subretinal injection contributed to the resorption of hemorrhage in the shortest possible time and improved visual functions from 0.02 to 0.6.Conclusions. The presented comprehensive approach of PCV treatment and its complications made possible to provide social rehabilitation of the patient and to preserve high values of visual functions in the affected eye.