Researchers identified clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy (PECH), according to a study published in Archivos de la Sociedad Española de Oftalmología. These findings may assist clinicians in making the correct differential diagnosis and avoiding unnecessary treatment, according to the report.
Researchers enrolled 23 patients with PEHC (mean age at diagnosis, 79 years; eyes, 39) in the retrospective analysis. All patients underwent comprehensive ophthalmological examinations with slit lamp analysis. The primary objective was to determine the clinical characteristics of PECH.
Patients with active PECH or exudative age-related macular degeneration (AMD) were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. Patients with fibrotic phase PECH underwent clinical follow-up and observation without treatment. Follow-up time was a mean 6.1±3.8 years.
Overall, women were more likely to have PEHC (73.9%) and experience it at a younger age (78.8±7.3 years) compared with men (80.7±8.4 years). Low vision was noted in 66.6% of the cohort, and 28.2% of patients were asymptomatic.
The most common metabolic risk factor was hypertension (16 patients). Seven patients had hypercholesterolemia. Most patients were treated with oral antiplatelet drugs (26%) or oral anticoagulants (30.4%).
Primary open-angle glaucoma (POAG) was the ocular disease most likely to be associated with PEHC (13%). Half of patients had undergone cataract surgery before PEHC diagnosis. Bleeding or exudation occurred in 61.5% of cases and choroidal melanoma occurred in 9 eyes.
Most patients had bilateral involvement in PEHC, and the involvement tended to present symmetrically. Lesions largely occurred in the inferior temporal quadrant (84.6%). Drusen were identified in the macular region of 33 eyes. Optical coherence tomography (OCT) most frequently identified macular fibrosis and cystic macular edema (35.9%).
Anti-VEGF injections were the most common treatment used to combat PEHC (60%). Two-thirds of those cases had active wet AMD. Half of the eyes treated with anti-VEGF experienced a complete resolution of lesions in the periphery and did not require additional intravitreal injections. Achievement of retinal pigment epithelium (RPE) atrophy associated with areas of subretinal fibrosis took about 5 months. Lesions in the remaining 7 eyes partially resolved but necessitated more IVI. Stability lasted a mean 4 months.
“PEHC is a rare disease, often associated with AMD, which typically presents as a peripheral mass and can be confused with choroidal melanoma, hence the importance of learning to identify it and making the differential diagnosis with intraocular tumours to avoid unnecessary treatment,” according to the researchers. “Anti-angiogenic therapy is effective in most patients in the active phase (exudative/hemorrhagic), leading to fibrosis of the hemorrhagic areas in the periphery.”
Study limitations include a retrospective nature and single center design.
Larrea J, Sanchez-Avila RM, Villota-Deleu E, et al. Clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy in a referral center in Spain. Arch Soc Esp Oftalmol. Published online May 28, 2022. doi: 10.1016/j.oftal.2022.04.003