息肉状脉络膜血管病变发生大出血的危险因素和治疗进展OA

Polypoidal choroidal vasculopathy(PCV)is a common blinding disease in Asian populations.Massive hemorrhage complications secondary to PCV includes subretinal hemorrhage(SRH)and vitreous hemorrhage(VH).The risk factors for SRH include a long duration,clustered PCV,non-regression of polyp lesions and presented with retinal pigment epithelial detachment.The treatments for SRH including anti-vascular endothelial growth factor drugs,photodynamic therapy,laser,vitreous pneumatic displacement,intravenously injected tissue plasminogen activator,vitrectomy and combination therapy.Whether macular fovea is involved and the time since bleeding onset are the main factors affecting the choice of treatment for SRH.Older age of onset,higher white blood cell count,higher aspartate amino transferase and alanine amino transferase ratio,longer activated partial thromboplastin time retinal pigment epithelium detachment,photodynamic therapy history,intravitreal injection history larger SRH area and presented with retinal pigment epithelial detachment were associated with higher risk of VH.PCV patients with massive VH should be treated with vitrectomy,while the timing and technique of operation should be paid attention to.At present,the risk factors of PCV massive bleeding are not completedly clear,and its treatment methods are diverse,which requires a large number of studies to prove its effectiveness and establish expert diagnosis and treatment consensus.