Causes of postoperative fibrotic scarring in hemorrhagic polypoidal choroidal vasculopathy

Abstract Purpose To investigate the causes of postoperative fibrotic scarring in hemorrhagic polypoidal choroidal vasculopathy (PCV). Methods One hundred thirteen PCV patients with submacular hemorrhage (SMH, 54 eyes) or hemorrhagic retinal detachment (HRD, 59 eyes) underwent various surgical interventions: vitreous injection (11 eyes), pars plana vitrectomy (PPV) + submacular injection (SMI) (69 eyes), or PPV with external drainage (ED) (33 eyes). Patients were divided into early (≤ 14 days) and late treatment groups based on the timing of the surgery. Postoperative scarring and best-corrected visual acuity (BCVA) were monitored. Results The incidence of postoperative scarring in hemorrhagic PCV was 56.64%. This scarring was significantly associated with advanced age, a prolonged interval between symptom onset and surgery, preoperative vitreous hemorrhage (VH), foveal lesions, and different surgical interventions ( p < 0.05). The scarring rate was higher in the vitreous injection group compared to the PPV + SMI group ( p = 0.036). Multivariate analysis revealed that foveal lesions were significantly related to postoperative scarring ( p = 0.002). Furthermore, retinal pigment epithelium (RPE) tears at the fovea substantially increased the risk of postoperative scarring ( p = 0.000). At the final follow-up, postoperative BCVA was significantly lower in patients with foveal lesions than in those with extrafoveal lesions. Conclusions There was a high incidence of postoperative fibrotic scarring in patients with polypoid lesions located in the fovea, particularly among those who received delayed treatment and had preoperative VH and vitreous injection treated solely with anti-VEGF agents. RPE tears may be a significant contributor to postoperative scarring.