Clinical Characteristics and Treatment Outcomes of Breakthrough Vitreous Hemorrhage in Peripheral Exudative Hemorrhagic Chorioretinopathy (PEHCR).

Purpose: To evaluate the clinical characteristics and treatment outcomes of breakthrough vitreous hemorrhage secondary to peripheral exudative hemorrhagic chorioretinopathy (PEHCR).

Methods: This retrospective study included 14 eyes from 14 patients with vitreous hemorrhage secondary to peripheral retinochoroidal mass lesions. Data collected included demographic profiles, clinical presentation, multimodal imaging findings, and treatment outcomes following pars plana vitrectomy (PPV), intravitreal anti-VEGF injections, or laser photocoagulation.

Results: The median age at presentation was 83 years (range, 58-91), with nine females (64.3%). Median presenting visual acuity (VA) was 1.3 logMAR (range, 0.3-2.7). All patients had normal intraocular pressure. Bilateral PEHCR was observed in 50%, though hemorrhage occurred unilaterally. Unifocal lesions were present in 71.4%, with a mean lesion thickness of 3.4 mm (range, 1.5-6.8 mm). Dense vitreous hemorrhage obscuring posterior pole details was seen in eight eyes (57.1%) and required PPV. The remaining six eyes, with moderate hemorrhage, improved spontaneously without surgery. Intravitreal anti-VEGF therapy was administered in five eyes for macular involvement or to prevent recurrent hemorrhage. At a median follow-up of 11.7 months (range, 3-63), median VA improved to 0.36 logMAR (range, 0.1-2.0). The mean VA gain was 0.76 logMAR in the vitrectomy group (p = 0.004) and 0.55 logMAR in eyes without macular involvement (p = 0.024). However, five eyes (35.7%) had final VA ≤ 20/200 due to macular pathology consistent with age-related macular degeneration or polypoidal choroidal vasculopathy-like changes.

Conclusion: PEHCR with breakthrough vitreous hemorrhage is a rare but important diagnostic consideration in patients presenting with peripheral retinochoroidal mass-like lesions. PPV and intravitreal anti-VEGF therapy may improve visual outcomes in these cases. However, visual recovery may be limited in cases with macular involvement due to irreversible retinal damage. Early diagnosis and tailored management are essential to optimize outcomes and avoid misdiagnosis.