Hyperpigmented spots after treatment for submacular hemorrhage secondary to polypoidal choroidal vasculopathy.

PURPOSE: To investigate the characteristics and clinical course of hyperpigmented spots after submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV).

METHODS: This retrospective, observational study included 87 eyes initially treated with three anti-vascular endothelial growth factor (VEGF) injections for submacular hemorrhage secondary to PCV. Patients were divided into two groups according to the presence of multiple small, dark-gray or black, pigmented lesions after initial treatment: the hyperpigmented spots group and no-hyperpigmented spots group. Baseline characteristics and re-activation of the lesion were compared between the two groups.

RESULTS: The mean follow-up period was 30.6 ± 12.9 months, and 41 eyes (47.1%) were included in the hyperpigmented spots group. The hyperpigmented spots group exhibited greater extent of hemorrhage (P < 0.001) and greater central foveal thickness (P = 0.045) than did the no-hyperpigmented spots group. In the hyperpigmented spots group, re-activation of the lesion was noted in 17 eyes (41.5%) at a mean duration of 15.4 ± 12.7 months after the third anti-VEGF injection. In the no-hyperpigmented spots group, re-activation was noted in 28 eyes (60.9%) at a mean duration of 6.4 ± 4.0 months after the third injection. Kaplan-Meier analysis with log-rank test revealed a significant difference in the re-activation of the lesion between the two groups (P = 0.006).

CONCLUSIONS: Hyperpigmented spots were associated with a large amount of submacular hemorrhage in PCV. The low incidence of re-activation and late re-activation of the lesion in eyes with hyperpigmented spots suggest that a novel follow-up and treatment strategy is required for this condition.