Hip joint stress distribution changes depending on three-dimensional pelvic orientation: Finite-element analysis.

BACKGROUND: Pelvis experiences changes in its orientation due to the alignment of the hip joint and spine, and its orientation might affect both joints. Pelvic tilt on the sagittal plane has been widely discussed; however, the pelvis is oriented also on the coronal and horizontal planes. This study aimed to examine how stress distribution on intact hip joint changes under the three-dimensional pelvic orientation. METHODS: Computed tomography data of five patients with unilateral pelvic girdle were analyzed. Thirteen models were evaluated by the MECHANICAL FINDER: neutral position at 0°; 10° and 20° anterior and posterior pelvic tilt; 10° and 20° pelvic hike and drop; 10° and 20° pelvic forward and backward rotation. Stress assessment was performed in four parts of the acetabulum: anterosuperior, posterosuperior, posteroinferior, and central parts. RESULTS: Compared with the neutral position, the mean value of the equivalent stress and maximum principal stress in the anterosuperior part significantly increased by 1.51 times and 1.57 times at 20° posterior tilt, respectively. The maximum principal stress in the anterosuperior part significantly increased by 1.44 times at 20° hike. A significant increase of 1.45 times was found in the maximum principal stress in the anterosuperior part at 20° forward rotation. CONCLUSIONS: Local stress accumulated in the anterosuperior acetabulum at the posterior pelvic tilt, pelvic hike, and pelvic forward rotation, which might lead to hip overload. The effect of posterior pelvic tilt appears to be greater for the hip joint than at the pelvic hike or forward rotation.

Retinal sensitivity after resolution of the macular edema associated with retinal vein occlusion.

PURPOSE: To study the correlation of retinal sensitivity with both morphologic changes in the macula and status of retinal capillary perfusion, after resolution of the macular edema associated with retinal vein occlusion (RVO). METHODS: Retinal sensitivity in the macular area was examined with the Micro Perimeter 1 in 24 eyes after resolution of the macular edema associated with RVO. Using spectral-domain optical coherence tomography, 6 mm × 6 mm areas of macula were examined with 256 sequential horizontal scans. Condition of the photoreceptor layer was evaluated depending upon detection of the junctions between inner and outer segments of the photoreceptors (IS/OS). Fluorescein angiography was performed in 19 eyes. RESULTS: Mean retinal sensitivity on the affected side of the retina was significantly decreased (p < 0.001). On the affected side, the mean retinal sensitivity within the area of deteriorated IS/OS was significantly less (3.8 ± 4.8 dB) than that within areas with complete IS/OS (10.1 ± 6.4 dB, p < 0.001). Mean retinal sensitivity within nonperfused areas was extremely low (0.3 ± 1.3 dB), compared with that in perfused retina (10.9 ± 5.9 dB, p < 0.001). In eyes with a broken foveal capillary ring (FCR), the marked decline in retinal sensitivity was seen within the area where the FCR was broken; this was not seen in eyes with an intact FCR. CONCLUSION: Retinal function was decreased markedly in areas with a damaged photoreceptor layer due to RVO, and was lethally decreased within nonperfused areas. Due to the various limitations of the current study, including implementation of fluorescein angiography in limited number of eyes, wide range of follow-up, and heterogeneity of pretreatments, further prospective studies are necessary to confirm the current findings.

Association of lesion size and visual prognosis to polypoidal choroidal vasculopathy.

PURPOSE: To investigate the progression of vascular lesions of polypoidal choroidal vasculopathy (PCV) as viewed with indocyanine green angiography and the visual prognosis of these eyes. DESIGN: Retrospective case study. METHODS: We reviewed retrospectively the medical records of 88 consecutive patients (88 eyes) with PCV who had been examined with indocyanine green angiography for more than 2 years. RESULTS: Depending on the initial area of the vascular lesion, eyes were divided into smaller PCV (baseline area of lesion being < 1 disc area [DA], n = 22) and larger PCV (baseline area of lesion being ≥ 1 DA, n = 66). In larger PCV, the mean area of the lesion progressed significantly from 6.49 ± 8.96 mm(2) to 16.27 ± 14.19 mm(2) (P < .0001) with marked deterioration of visual acuity (P < .0001) during follow-up. In contrast, smaller PCV often showed minimal progression of the lesion, only limited exudative change, and the eyes maintained their initially good vision to the final visit. Smaller PCV lesions rarely progressed to extensive PCV lesions. Severe vision-threatening complications (ie, suprachoroidal hemorrhage, vitreous hemorrhage, and tears of the retinal pigment epithelium) were seen only in eyes with larger PCV, and in studying single nucleotide polymorphisms A69S of ARMS2 genes, there was a significant difference in T allele frequency between individuals with smaller PCV and those with larger PCV (20.2% vs 79.8%; P = .0235). CONCLUSIONS: PCV with small vascular lesions shows minimal progression and no vision-threatening complications, and these eyes often maintain good visual acuity for a long time.

High-resolution imaging of resolved central serous chorioretinopathy using adaptive optics scanning laser ophthalmoscopy.

OBJECTIVE: To compare pathologic changes in photoreceptors in eyes with resolved central serous chorioretinopathy (CSC) seen on high-resolution images obtained by adaptive optics scanning laser ophthalmoscopy (AO SLO) with visual acuity (VA) and findings on spectral-domain optical coherence tomography (SD OCT). DESIGN: Observational case series. PARTICIPANTS: Forty-five eyes of 38 patients with resolved CSC and 20 normal eyes of 20 volunteer subjects. METHODS: All patients underwent a full ophthalmologic examination, SD OCT, and imaging with an original prototype AO SLO system fabricated using liquid crystal-on-silicon technology. MAIN OUTCOME MEASURES: Cone mosaic patterns and cone density on AO SLO images and VA in eyes with CSC. RESULTS: In normal eyes, AO SLO images showed a regular photoreceptor mosaic pattern and average cone densities 0.2, 0.5, and 1.0 mm from the central fovea of 67,900, 33,320, and 14,450 cones/mm(2). In eyes with CSC, cone densities were significantly lower at each distance from the central fovea (P = 0.009 at 0.2 mm, P = 0.007 at 0.5 mm, and P = 0.004 at 1.0 mm), and 2 distinct cone mosaic patterns were seen. Group 1 CSC eyes had regular cone mosaic patterns with small dark regions. Group 2 CSC eyes had irregular mosaic patterns with large dark regions. Compared with group 1, group 2 had significantly lower average cone density and worse average logarithm of the minimum angle of resolution (logMAR) VA (P<0.001). Mean cone density in eyes with disruptions in the photoreceptor inner and outer segment (IS/OS) junction or in the intermediate line on SD OCT images was significantly lower than that in eyes with an intact IS/OS junction or intermediate line (P<0.001 for both). Cone density 0.2 mm from the central fovea correlated with logMAR VA and mean foveal thickness (1-mm diameter area) measured on SD OCT images (P<0.001 for both). CONCLUSIONS: Adaptive optics SLO images showed abnormal cone mosaic patterns and reduced cone densities in eyes with resolved CSC, and these abnormalities were associated with VA loss, suggesting that AO SLO is a useful means to detect and measure cone abnormalities associated with VA loss in these eyes.

Relationship between retinal sensitivity and morphologic changes in eyes with confluent soft drusen.

PURPOSE: To examine the relationship between retinal sensitivity and morphologic changes in the macular area of eyes with confluent soft drusen. METHODS: We retrospectively reviewed the medical records of the 21 consecutive patients (22 eyes) who had confluent soft drusen in the macular area. Using spectral-domain optical coherence tomography, a 6 x 6-mm area of each macula was examined with 256 sequential horizontal scans. Microperimetry in the macular area was carried out using the Micro Perimeter 1. RESULTS: Spectral-domain optical coherence tomography images showed that protrusion of the retinal pigment epithelium (RPE) corresponded to the site of the confluent soft drusen. In addition, irregularities of the reflective line of the junction between inner and outer segments (IS/OS) of the photoreceptors were noted in 17 (77.3%) eyes. These irregularities were seen in the area with the protrusion of RPE. At 510 (68.1%) of 748 points with an intact retina, retinal sensitivity was 14 decibels or better. However, a retinal sensitivity of 14 decibels or better was obtained at 38.9% of points in irregular RPE with an intact IS/OS line, but at only 15.2% of points with an irregular IS/OS line. The mean retinal sensitivities within the area of irregular RPE with an intact IS/OS line, or in areas with an irregular IS/OS line, respectively, were significantly lower than that of intact retina (P < 0.0001). CONCLUSION: Eyes with confluent soft drusen often show focal areas with reduced retinal function, areas that are consistent with irregularity of the RPE or of the IS/OS line.

Restoration of outer segments of foveal photoreceptors after resolution of central serous chorioretinopathy.

PURPOSE: To study morphologically and functionally the prognosis of damaged outer segments of the foveal photoreceptor layer in eyes with resolved central serous chorioretinopathy (CSC). METHODS: We studied retrospectively the medical records of 70 patients (74 eyes) with resolved CSC. Optical coherence tomography was used to detect the junctions between inner and outer segments of the photoreceptors (IS/OS) as a hallmark of the integrity of the outer photoreceptor layer. RESULTS: In 53 eyes (71.6%), the IS/OS line was clearly detected beneath the fovea immediately after resolution of the retinal detachment, with good visual acuity (VA). In the remaining 21 eyes (28.4%), however, the foveal IS/OS line could not be detected shortly after resolution of CSC, and VA was variable, ranging from 0.1 to 1.5 (median, 0.9). Of these 21 eyes, 15 had a follow-up examination with OCT, and in four the foveal IS/OS line was not detected at the follow-up and vision in these eyes remained poor. However, nine eyes showed recovery of the foveal IS/OS line during follow-up, and these eyes had substantial visual recovery. CONCLUSIONS: Immediately after resolution of active CSC, although the IS/OS line cannot be detected beneath the fovea, it often shows restoration over time, with visual recovery, though in some eyes no restoration takes place and the prognosis remains poor.

Punctate hyperfluorescent spots associated with central serous chorioretinopathy as seen on indocyanine green angiography.

PURPOSE: The purpose of this study was to examine indocyanine green angiography of eyes with central serous chorioretinopathy (CSC). METHODS: We retrospectively studied the medical records of 39 patients (41 eyes) with active CSC who were <50 years of age. All patients had undergone fluorescein angiography and indocyanine green angiography using a confocal laser scanning system. RESULTS: On indocyanine green angiography, most patients showed choroidal abnormalities, such as filling delay, venous dilation, subretinal leakage, or focal areas of hyperfluorescence, that were attributed to choroidal vascular hyperpermeability. In addition, punctate hyperfluorescent spots were seen in 38 of 41 eyes (93%) with active CSC and in 29 of 37 fellow eyes (78%); these spots were seen in the macular area and outside the vascular arcade or in peripapillary locations, and they often appeared as clusters of distinct spots. A cluster of punctate hyperfluorescent spots was seen on midphase indocyanine green angiography, and focal areas of hyperfluorescence often appeared to expand with time from these punctate hyperfluorescent spots. CONCLUSION: Focal areas of hyperpermeability in CSC may be derived from the leakage of tiny punctate spots in the inner choroid. Hyperpermeability of these lesions may be involved in the development of serous retinal detachment associated with CSC.

Central retinal sensitivity after intravitreal injection of bevacizumab for myopic choroidal neovascularization.

PURPOSE: To evaluate retinal sensitivity in the macular area after intravitreal injection of bevacizumab in eyes with myopic choroidal neovascularization (mCNV). DESIGN: Prospective interventional case series. METHODS: Twenty-two eyes of 21 patients with mCNV were treated with intravitreal injections of bevacizumab. Microperimetry in the macular area was performed with a Micro Perimeter-1 (Nidek, Vigonza, Italy) before, and at 1 month and 6 months after treatment. RESULTS: After treatment, visual acuity (VA) and central retinal sensitivity were improved significantly. Mean VA in logarithm of the minimal angle of resolution (logMAR) fashion improved from 0.67 +/- 0.34 to 0.43 +/- 0.33 at 1 month, and to 0.34 +/- 0.26 at 6 months [P < .01, respectively]. Mean retinal sensitivity within the central 10 degree field improved from 4.8 +/- 2.8 decibels (dB) to 6.5 +/- 3.2 dB at 1 month and to 7.4 +/- 4.4 dB at 6 months [P < .01, respectively]. These improvements were more prominent in eyes with juxtafoveal mCNV than in eyes with subfoveal mCNV. With treatment, the mean number of measurement points within the scotomas decreased significantly; the absolute scotoma was reduced substantially in 15 (68%) eyes at 6 months. Unfortunately, the absolute scotoma was significantly enlarged in 1 eye (5%) at 1 month and in 4 eyes (18%) at 6 months. Also at 6 months, chorioretinal atrophy had developed in the macular area in 4 eyes (18%). CONCLUSIONS: Although intravitreal injection of bevacizumab improved retinal sensitivity in the macular area, some eyes showed enlargement of the scotoma after this treatment.

Improved visualization of polypoidal choroidal vasculopathy lesions using spectral-domain optical coherence tomography.

PURPOSE: To report the tomographic features of vascular lesions beneath the retinal pigment epithelium in eyes with polypoidal choroidal vasculopathy by using spectral-domain optical coherence tomography (SD-OCT). DESIGN: Retrospective observational case series. METHODS: Angiograms and images obtained using the prototype SD-OCT system were compared for 21 eyes of 21 patients with polypoidal choroidal vasculopathy to identify sub-retinal pigment epithelium abnormalities visible on three-dimensional and enhanced SD-OCT images. RESULTS: On angiography, a branching vascular network and at least 1 polypoidal lesion were visible in all 21 eyes; 10 eyes also had pigment epithelial detachment (PED). SD-OCT revealed a thin straight line of high reflectivity-Bruch's membrane-associated with the branching vascular network in all 21 eyes, polypoidal lesions, 19 (90%) of the 21 eyes; and PED, 9 (90%) of the 10 eyes with PED. The vascular abnormalities of polypoidal choroidal vasculopathy (polypoidal lesion and branching vascular network) identified with angiograms were visualized on SD-OCT images in 20 of the 21 eyes (95%) as areas of moderate reflectivity between the clearly delineated abnormal section of retinal pigment epithelium and Bruch's membrane. CONCLUSIONS: Enhanced SD-OCT imaging clearly depicted Bruch's membrane beneath areas of abnormal retinal pigment epithelium in the same locations where the vascular abnormalities of polypoidal choroidal vasculopathy were evident on angiography.

Retinal sensitivity measured with the micro perimeter 1 after resolution of central serous chorioretinopathy.

PURPOSE: To examine retinal sensitivity in the macular area of eyes with resolved central serous chorioretinopathy (CSC). DESIGN: Retrospective chart review. METHODS: We studied retrospectively the medical records of 21 patients (21 eyes) with resolved CSC. Using spectral-domain optical coherence tomography (SD-OCT), 6 x 6-mm areas of macula were examined with 256 sequential horizontal scans. Microperimetry in the macular area was performed with the Micro Perimeter 1 (Nidek, Vigonza, Italy). Seventy-two measurement points were located within the central 10 degrees of the macula. RESULTS: In eyes with resolved CSC, most OCT images showed a physiologically normal appearance. However, irregularities of the retinal pigment epithelium (RPE) were detected in 11 eyes, and focal defects of the junctions between inner and outer segments (IS/OS) of the photoreceptors were noted in 15 eyes. These abnormalities often were seen within the foveal region. At 983 (79.8%) of 1,232 points with intact retina, retinal sensitivity was 16 decibels (dB) or better. However, a retinal sensitivity of 16 dB or better was obtained at 34.0% of points with irregular RPE and in 20.0% of points with defects of the IS/OS. The mean retinal sensitivities within the area with irregular RPE (13.4 +/- 4.8 dB) or with defects of the IS/OS (11.5 +/- 4.2 dB) were significantly lower than that of intact retina (17.5 +/- 2.4 dB; P < .0001). CONCLUSIONS: Eyes with resolved CSC often show focal areas with reduced retinal function, which are consistent with irregularity of the RPE or with defects of the IS/OS.

Macular polypoidal choroidal vasculopathy with a remote lesion.

PURPOSE: To report cases of the macular type of polypoidal choroidal vasculopathy with a remote lesion. METHODS: We report six patients (seven eyes) with polypoidal choroidal vasculopathy who had macular and remote lesions. These eyes were examined with angiography and tomography. RESULTS: All seven eyes showed an exudative macular lesion beneath the fovea. In addition, all eyes showed remote polypoidal lesions that were not connected to the macular lesions; the remote lesion was detected outside of the vascular arcade in five eyes, superotemporally beside the optic disc in one eye and on the nasal side of the optic disc in one eye. Indocyanine green angiography, fluorescein angiography and optical coherence tomography failed to reveal any sign of a branching vascular network or choroidal neovascularization that connected the macular lesion with the more remote lesion. At the initial visit, visual acuity in the seven eyes ranged from 6/150 to 6/9 (median, 6/15). Four eyes underwent photodynamic therapy to the exudative macular lesion. During 27.6 +/- 14.3 months of follow up, no worsening was detected in any of the remote lesions. Median visual acuity was 6/60 at the final visit. CONCLUSIONS: Some patients with macular polypoidal choroidal vasculopathy also have a remote lesion, although the remote lesion seems to have only a minor effect on visual outcome.

Retinal pigment epithelial tear in polypoidal choroidal vasculopathy.

PURPOSE: To study the clinical characteristics of tears of the retinal pigment epithelium (RPE) in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: The authors report eight eyes of eight patients with PCV that had tears of the RPE. These were examined with angiography and tomography. RESULTS: Eight eyes of eight patients (seven men and one woman) had RPE tears at the margin of a serosanguineous pigment epithelial detachment (PED) associated with PCV. Tears of the RPE were detected at the initial visit in one eye and during follow-up without any treatment in five eyes. In two eyes, the RPE tears were detected 3 months and 6 months, respectively, after photodynamic therapy. In all eyes, the RPE tears were detected at the side opposite to the polypoidal lesions of the PEDs, and the fovea was not involved in the RPE tear. Visual acuity in the seven eyes without RPE tears on presentation ranged from 20/100 to 20/16 (median, 20/32). During follow-up, three of these eyes lost three or more lines of vision. At the final examination, while three of these eyes had visual acuity of 20/25 or better, the other four had visual acuity of 20/200 or worse. CONCLUSION: In eyes with PCV, RPE tears can occur at the margin of serosanguineous PEDs-either spontaneously or after photodynamic therapy.

[Improved visualization of foveal pathologies using fourier-domain optical coherence tomography].

PURPOSE: To demonstrate the improved visualization of pathological foveal structures by a prototytpe Fourier-domain optical coherence tomography instrument (FD-OCT). MATERIALS AND METHODS: We constructed a prototype FD-OCT instrument with an axial resultion of 4.3, m in tissues and an acquisition rate of approximately 18,700 axial scans per second. A raster-scan protocol comprising 256 x 256 axial scans was used in a 2.8 x 2.8 mm area to obtain a 3D-OCT data set. Images of the fovea were obtained in patients with central serous chorioretinopathy(5 eyes of 5 patients), macular hole (6 eyes of 5 patients), pigment epithelial detachment (PED : 4 eyes of 4 patients), and epiretinal membrane (4 eyes of 4 patients). RESULTS: Normal fovea showed two lines corresponding to a strong backreflection from the external limiting membrane (ELM) and the inner and outer segment junctions (IS/OS). With the exception of the eyes with epiretinal membrane, the IS/ OS line that corresponded to the region where the photoreceptor layer shifted inward disappeared in all eyes. The ELM lines were clearly observed in the same region, except for the one eye with the most steeply protruding PED. CONCLUSIONS: The use of FD-OCT enables improved visualization of the pathological structural changes in the foveal photoreceptor layer of patients with macular diseases.

Three-dimensional imaging of the foveal photoreceptor layer in central serous chorioretinopathy using high-speed optical coherence tomography.

OBJECTIVE: To describe the 3-dimensional (3-D) imaging of the pathologic changes in the foveal photoreceptor layer in eyes with central serous chorioretinopathy (CSC) using high-speed optical coherence tomography (OCT). DESIGN: Prospective observational case series. PARTICIPANTS: Twenty-seven eyes of 27 consecutive patients with various stages of CSC. METHODS: A prototype high-speed OCT system was fabricated for patient examinations based on Fourier domain OCT. The system had a sensitivity of 98 dB, a tissue axial resolution of 4.3 mum, and an acquisition rate of approximately 18700 axial scans per second. Three-dimensional imaging was performed based on a raster-scan protocol. MAIN OUTCOME MEASURES: Anatomic features of CSC distinguished by 3-D OCT. RESULTS: A line corresponding to backreflection from the external limiting membrane (ELM) was visible in images from eyes with all stages of CSC, including 6 in the acute, 5 in the chronic, and 9 in the recurrent phase of retinal detachment and 11 examined in the quiescent phase (including 4 reexamined after reattachment). Backreflection from the photoreceptor inner and outer segment junction (IS/OS) was missing before but present after reattachment. The ELM line bordered the photoreceptor nuclear and inner segment layers, clearly showing that CSC primarily alters the outer segment (OS) layer. Punctate areas of intense reflectivity were observed more frequently in the OS layer of detached retinas in cases of chronic or recurrent versus acute CSC (P<0.05, chi-square test). Of 11 eyes with reattached macula, 3 eyes with large defects in the subfoveal IS/OS had poor visual acuity (VA), and 8 eyes with small or no defects had good VA (P<0.05 and P<0.001, chi-square test). Decreases in foveal full and outer thickness were associated with VA loss (P<0.05 and P<0.001, Spearman rank correlation test). CONCLUSIONS: Three-dimensional OCT imaging delineates the microstructural changes that occur within the photoreceptor layers and demonstrates the spatial relationship between the laterally spreading or scattering microstructures and the fovea in eyes with CSC. Visualization of the 3-D relationship between the ELM and each photoreceptor layer before and after macular reattachment facilitates understanding of anatomic and vision changes that result from CSC.

Three-dimensional imaging of macular holes with high-speed optical coherence tomography.

OBJECTIVE: To demonstrate the advantages of 3-dimensional imaging of macular hole pathology using new-generation high-speed optical coherence tomography (OCT). DESIGN: Prospective observational case series. PARTICIPANTS: Twenty-one eyes from 20 consecutive patients diagnosed with a macular hole. METHODS: A prototype high-speed OCT system was built based on a Fourier-domain OCT (FD OCT) technology for patient examination. The system has achieved sensitivity of approximately 98 decibels, axial resolution of approximately 4.3 mum in tissue, and an acquisition rate of approximately 18,700 axial scans per second. Three-dimensional imaging of macular hole pathology was performed based on a raster scan protocol consisting of 256x256 axial scans. All patients were imaged with 3-dimensional OCT, Stratus OCT, and OCT Ophthalmoscope C7. MAIN OUTCOME MEASURES: Images of macular hole pathologies obtained by 3-dimensional OCT and standard OCT instruments. RESULTS: The 3-dimensional OCT imaging successfully generated realistic 3-dimensional images of the vitreofoveal interface and intraretinal microstructures associated with a macular hole. The 3-dimensional overview of the vitreofoveal interface was helpful in gaining an immediate understanding of the dynamic interactions of the vitreous and fovea. Observations of consecutive en face images in combination with conventional longitudinal images and of cross-sectional images in combination with sectioned volume images enabled identification of intraretinal microstructures and their 3-dimensional extension associated with a macular hole, such as subfoveal structural changes after vitreous traction, connection of the flap to intraretinal structures, the external limiting membrane (ELM) and its disruption, and elevated photoreceptor inner and outer segments delineated by the ELM. The appearance of inner-wall images of a macular hole produced by photoreceptor inner and outer segment backreflection varied throughout macular hole stages. CONCLUSIONS: Three-dimensional imaging of macular holes with high-speed OCT based on FD OCT technology offers 3-dimensional overviews that facilitate understanding of the abnormalities in the vitreofoveal interface. It also provides consecutive orthogonal images that allow much more precise and minute observation of 3-dimensionally extending intraretinal structural changes associated with a macular hole than conventional OCT imaging, especially in the photoreceptor inner and outer segments.

Recurrent bleeding after photodynamic therapy in polypoidal choroidal vasculopathy.

PURPOSE: To report a case of recurrent bleeding after photodynamic therapy (PDT) in an eye with polypoidal choroidal vasculopathy (PCV). DESIGN: Interventional case report. METHODS: A 73-year-old man was treated in the left eye for PCV with PDT. RESULTS: Two weeks after PDT, his left eye showed extensive subretinal hemorrhage, with a slight vision loss. Three months after PDT, subretinal hemorrhage was almost absorbed. He received a second session of PDT to the remaining choroidal neovascularization. Two weeks thereafter, his left eye showed massive suprachoroidal hemorrhage with further vision loss. One month after the second PDT, visual acuity was decreased to no light perception as a result of massive vitreous hemorrhage. Although the patient underwent pars plana vitrectomy, visual acuity in the left eye remained hand motion as a result of massive suprachoroidal hemorrhage. CONCLUSIONS: Ophthalmologists and patients should be aware of the risk of massive bleeding after PDT in eyes with PCV.