Shortest Distance From Fovea to Subfoveal Hemorrhage Border Is Important in Patients With Neovascular Age-related Macular Degeneration

Abstract

Purpose: To identify factors influencing visual outcome in patients with neovascular age-related macular degeneration (NVAMD) and subfoveal hemorrhage (SFH) treated with anti-vascular endothelial growth factor (VEGF) agents.

Design: Retrospective case series.

Methods: Anti-VEGF-treated eyes with SFH > 1 disc area (DA) were identified (n = 16) and changes in visual acuity (VA) and central subfield thickness (CST) from baseline to last follow-up, along with SFH area, thickness, minimum distance from fovea to SFH border, and time to resolution, were determined.

Results: At baseline, mean (± standard error of the mean) size and thickness of SFH were 14.9 ± 2.8 DA and 386.6 ± 46.9 μm, and mean Snellen VA and CST were 20/250 and 591.7 ± 57.0 μm. Median follow-up was 47.6 months. While more than 50% of patients had VA ≤ 20/200 at baseline and all time points through week 48, the percentage of patients with VA ≥ 20/50 increased to 30%-40% at months 6 and 12 and remained stable through month 48. Spearman rank correlation demonstrated 2 independent variables that correlated with good visual outcome, smaller area of SFH at baseline (r = -0.630; P = .009), and high frequency of anti-VEGF injections (r = 0.646; P = .007). In exceptional patients with good visual outcome despite large baseline SFH, shortest distance between the fovea and hemorrhage border significantly correlated with baseline VA (r = -0.503, P = .047) and final VA (r = -0.575, P = .02).

Conclusions: Patients with NVAMD and thick SFH, but short distance between fovea and uninvolved retina, can have good visual outcomes when given frequent anti-VEGF injections.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

FIGURE 1.

Identification of patients with subfoveal hemorrhage owing to neovascular age-related macular degeneration (NVAMD) treated with intravitreous injections of a vascular endothelial growth factor neutralizing protein. DA = disc area; SD-OCT = spectral-domain optical coherence tomography; SFH = subfoveal hemorrhage; SRH = subretinal hemorrhage; VEGF = vascular endothelial growth factor.

FIGURE 2.

Visual outcomes in patients with subfoveal hemorrhage owing to neovascular age-related macular degeneration treated with intravitreous injections of a vascular endothelial growth factor neutralizing protein. (Top) Bar graphs show percentage of patients with visual acuity ≥20/50, 20/63 to 20/160, or ≤20/200 at baseline and 6, 12, 24, 36, 48, and 60 months after baseline. (Bottom) Bar graphs show percentage of patients that gained ≥3 lines from baseline, had change ≤3 lines, or lost ≥3 lines at 6, 12, 24, 36, 48, and 60 months after baseline.

FIGURE 3.

Images from baseline and last follow-up visit for patients with subfoveal hemorrhages owing to neovascular age-related macular degeneration. Color fundus photographs (CFP) or infrared (IR) images and horizontal spectral-domain optical coherence tomography (SD-OCT) scans through fovea in patients with subfoveal hemorrhage (SFH) organized in descending order of area of hemorrhage from 1 to 16. First column shows CFP or IR image at baseline (BL) visit and the area of SFH in disc areas is in the lower left corner. The second column shows the horizontal SD-OCT scan through the fovea at BL. Snellen visual acuity (VA) at BL is shown in the upper right corner, thickness of the SFH (μm) is shown in the lower right corner, and the distance from the fovea to the edge of the hemorrhage (μm) is shown in the lower left corner. The third column shows CFP or IR image at last follow-up visit, with time in months (M) after baseline in the upper left corner. The fourth column shows horizontal SD-OCT scan through the fovea at last follow-up visit, with VA shown in the upper right corner and number of anti-VEGF injections shown in the lower right corner.

FIGURE 3.

Images from baseline and last follow-up visit for patients with subfoveal hemorrhages owing to neovascular age-related macular degeneration. Color fundus photographs (CFP) or infrared (IR) images and horizontal spectral-domain optical coherence tomography (SD-OCT) scans through fovea in patients with subfoveal hemorrhage (SFH) organized in descending order of area of hemorrhage from 1 to 16. First column shows CFP or IR image at baseline (BL) visit and the area of SFH in disc areas is in the lower left corner. The second column shows the horizontal SD-OCT scan through the fovea at BL. Snellen visual acuity (VA) at BL is shown in the upper right corner, thickness of the SFH (μm) is shown in the lower right corner, and the distance from the fovea to the edge of the hemorrhage (μm) is shown in the lower left corner. The third column shows CFP or IR image at last follow-up visit, with time in months (M) after baseline in the upper left corner. The fourth column shows horizontal SD-OCT scan through the fovea at last follow-up visit, with VA shown in the upper right corner and number of anti-VEGF injections shown in the lower right corner.

FIGURE 4.

Anatomic outcomes in patients with subfoveal hemorrhage owing to neovascular age-related macular degeneration treated with intravitreous injections of a vascular endothelial growth factor neutralizing protein. Points show the mean (±95% confidence interval) central subfield thickness (CST) at baseline and 6, 12, 24, 36, 48, and 60 months after baseline. *P < .001 for difference from baseline by unadjusted mixedeffect regression model.