title: 23-Gauge vitrectomy with external drainage therapy as a novel procedure to displace massive submacular hemorrhage secondary to polypoidal choroidal vasculopathy.
abstract: BACKGROUND
  Massive subretinal hemorrhage (SRH) due to polypoidal choroidal vasculopathy (PCV) remains a challenging field and the best treatment is still not certain. In the present study, we performed a novel surgical method which combined 23-gauge vitrectomy with external drainage therapy for displace massive SRH secondary to PCV.
  
  
  METHODS
  From April 2015 to July 2015, 4 consecutive patients with massive SRH secondary to PCV received 23-gauge transconjunctival sutureless vitrectomy with external drainage therapy. Massive SRH was drained by scleral tunnel which was created using 30-gauge ultrathin needles during vitrectomy. We assessed the feasibility and safety of this procedure by analyzing best-corrected vision acuity (BCVA), central foveal thickness (CFT), and complication.
  
  
  RESULTS
  Four patients had a mean age of 63.8 ± 6.4 years (range: 59-73 years). The average interval between onset of symptoms of SRH and surgery was 23.8 ± 11.1 days (range: 10-35 days). Mean follow-up duration was 7.0 ± 0.8 months. All patients completed 6 months follow-up. Mean BCVA gradually improved during the follow-up period. At 6 months after treatment, mean BCVA was significantly improved in comparison to preoperative findings (P = 0.043, paired t test). One month after treatment, mean CFT was significantly thinner than baseline (P = 0.002, paired t test). No serious ocular or systemic adverse events were observed to be associated with combination of 23-gauge vitrectomy with external drainage therapy during the 6 months follow-up period.
  
  
  CONCLUSIONS
  Our results show that a combination of 23-gauge vitrectomy with external drainage therapy is a novel effective and safe procedure that may be a good alternative for massive SRH due to PCV.
authors: Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
authors: Hui
authors: H
authors: Liu
authors: Lu-Yi
authors: LY
authors: Zhang
authors: Xiao-Xia
authors: XX
authors: Li
authors: Miao-Qin
authors: MQ
authors: Wu
mesh_terms: D000368:Aged; D002829:Choroid / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D012494:Sampling Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*