Skip to main content

Advertisement

SpringerLink
Log in

Anti-VEGF therapy in symptomatic peripheral exudative hemorrhagic chorioretinopathy (PEHCR) involving the macula

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to describe the anatomical and functional outcome of vascular endothelial growth factor inhibitor (anti-VEGF) treatment in symptomatic peripheral exudative hemorrhagic chorioretinopathy (PEHCR) involving the macula.

Methods

Clinical records from patients seen between 2012 and 2013 at a single academic center were reviewed to identify PEHCR patients receiving anti-VEGF therapy due to disease-associated changes involving the macula. Affected eyes were either treated with consecutive intravitreal injections of anti-VEGF or vitrectomy combined with anti-VEGF followed by pro re nata injections.

Results

The mean age of the patients was 76 years (range 70–89 years). In all nine eyes, visual acuity was reduced due to central subretinal fluid. On average, three anti-VEGF injections (range 2–5 injections) were required initially to achieve complete resolution of macular subretinal fluid. In three eyes, subretinal fluid reappeared after an average of 10 months (range 5–16 months), and an average of 2.5 anti-VEGF injections (range 2–3 injections) were necessary to attain complete resolution of macular subretinal fluid a second time. Median visual acuity at the visit before the first injection was 1.0 logMAR (range 2.1-0.4 logMAR) and increased to 0.8 logMAR (range 2-0.1 logMAR) at the last visit.

Conclusion

Results of this study show that for cases in which PEHCR becomes symptomatic due to macular involvement, anti-VEGF treatment may have drying potential. Although vision was improved in some patients, it remained limited in cases with long-term macular involvement, precluding any definitive functional conclusion. However, we believe that the use of anti-VEGF agents should be recommended in PEHCR that threatens the macula. Due to its often self-limiting course, peripheral lesions should be closely observed. Larger studies are needed in order to provide clear evidence of the efficacy of anti-VEGF therapy in PEHCR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Annesley WH Jr (1980) Peripheral exudative hemorrhagic chorioretinopathy. Trans Am Ophthalmol Soc 78:321–364

    PubMed  PubMed Central  Google Scholar 

  2. Shields JA, Mashayekhi A, Ra S, Shields CL (2005) Pseudomelanomas of the posterior uveal tract: the 2006 Taylor R Smith Lecture. Retina 25:767–771

    Article  PubMed  Google Scholar 

  3. Shields CL, Salazar P, Mashayekhi A et al (2009) Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) simulating choroidal melanoma in 173 eyes. Ophthalmology 116:529–535

    Article  PubMed  Google Scholar 

  4. Barkmeier AJ, Kadikoy H, Holz ER et al (2011) Regression of serous macular detachment due to peripheral exudative hemorrhagic chorioretinopathy following intravitreal bevacizumab. Eur J Ophthalmol 21(4):506–508

    Article  PubMed  Google Scholar 

  5. Pinarci EY, Kilic I, Bayar SA et al (2013) Clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy and its response to bevacizumab therapy. Eye (Lond) 27(1):111–112

    Article  CAS  Google Scholar 

  6. Mantel I, Uffer S, Zografos L (2009) Peripheral exudative hemorrhagic chorioretinopathy: a clinical, angiographic, and histologic study. Am J Ophthalmol 148(6):932–938

    Article  PubMed  Google Scholar 

  7. Goldman DR, Freund KB, McCannel CA et al (2013) Peripheral polypoidal choroidal vasculopathy as a cause of peripheral exudative hemorrhagic chorioretinopathy: a report of 10 eyes. Retina 33(1):48–55

    Article  PubMed  Google Scholar 

  8. Bach M, Guntram K (1998) Sehschärfenbestimmung nach europäischer Norm: wissenschaftliche Grundlagen und Möglichkeiten der automatischen Messung. KlinMonbl Augenheilkunde 212(4):190–195

    Article  CAS  Google Scholar 

  9. Agarwal A (2012) Gass’ atlas of macular diseases fifth edition, Elsevier, 1(3):122

  10. Mirshahi A, Höhn F, Baatz H et al (2009) Peripheral exudative haemorrhagic chorioretinopathy: clinical and angiographic findings. Klin Monbl Augenheilkd 226(8):659–663

    Article  CAS  PubMed  Google Scholar 

  11. Xu Y, You Y, Du W et al (2012) Ocular pharmacokinetics of bevacizumab in vitrectomized eyes with silicone oil tamponade. Invest Ophthalmol Vis Sci 53(9):5221–5226

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Falavarjani KG, Modarres M, Nazari H (2010) Therapeutic effect of bevacizumab injected into the silicone oil in eyes with neovascular glaucoma after vitrectomy for advanced diabetic retinopathy. Eye (Lond) 24(4):717–719

    Article  CAS  Google Scholar 

  13. Manzano RP, Peyman GA, Khan P et al (2006) Testing intravitreal toxicity of bevacizumab (Avastin). Retina 26:257–261

    Article  PubMed  Google Scholar 

  14. Mantel I, Schalenbourg A, Zografos L (2012) Peripheral exudative hemorrhagic chorioretinopathy: polypoidal choroidal vasculopathy and hemodynamic modifications. Am J Ophthalmol 153(5):910–922

    Article  PubMed  Google Scholar 

  15. Mashayekhi A, Shields CL, Shields JA (2013) Peripheral exudative hemorrhagic chorioretinopathy: a variant of polypoidal choroidal vasculopathy? J Ophthalmic Vis Res 8(3):264–267

    PubMed  PubMed Central  Google Scholar 

  16. Tong JP, Chan WM, Liu DT et al (2006) Aqueous humor levels of vascular endothelial growth factor and pigment epithelium derived factor in polypoidal choroidal vasculopathy and choroidal neovascularization. Am J Ophthalmol 141:456–462

    Article  CAS  PubMed  Google Scholar 

  17. Matsuoka M, Ogata N, Otsuji T et al (2004) Expression of pigment epithelium derived factor and vascular endothelial growth factor in choroidal neovascular membranes and polypoidal choroidal vasculopathy. Br J Ophthalmol 88:809–815

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Statistical analysis was performed by Dr. Ulrich Gauger, medical statistician.

Conflict of interest

M. Rehak: payment for lectures including service on speakers bureaus, payment for manuscript preparation, travel/accommodations/meeting expenses. A.M. Joussen: payment for development of educational presentations and travel/accommodations/meeting expenses. All other authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements). All authors have non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

    Ira Seibel, Annette Hager, Tobias Duncker, Aline I. Riechardt, Daniela Nürnberg, Julian P. Klein, Matus Rehak & Antonia M. Joussen

Authors
  1. Ira Seibel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annette Hager
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tobias Duncker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aline I. Riechardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniela Nürnberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Julian P. Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matus Rehak
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonia M. Joussen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ira Seibel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seibel, I., Hager, A., Duncker, T. et al. Anti-VEGF therapy in symptomatic peripheral exudative hemorrhagic chorioretinopathy (PEHCR) involving the macula. Graefes Arch Clin Exp Ophthalmol 254, 653–659 (2016). https://doi.org/10.1007/s00417-015-3096-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-015-3096-x

Keywords

Search

Navigation