Intravitreal anti-vascular endothelial growth factor monotherapy for large submacular hemorrhage secondary to neovascular age-related macular degeneration

Abstract

Purpose: To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) monotherapy for large submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD).

Methods: A total of 49 treatment-naive patients (49 eyes) with large SMH (more than five disc areas (DAs)) secondary to nAMD were retrospectively included. All patients were treated with an initial series of 3 monthly intravitreal anti-VEGF injections, followed by as-needed injections. At the 12-month follow-up, changes in best-corrected visual acuity (BCVA), hemorrhage area, central foveal thickness, and development of vitreous hemorrhage after treatment were evaluated.

Results: The mean SMH area was 13.9 ± 8.8 disk areas (DAs) and mean symptom duration was 7.25 ± 5.9 days at baseline. The mean number of injections was 4.49 ± 1.61. Twelve months after treatment, the mean BCVA significantly improved from 1.14 ± 0.61 logarithm of the minimum angle of resolution (logMAR; 20/276, Snellen equivalent) to 0.82 ± 0.53 logMAR (20/132; P = 0.002). Twenty-four eyes (49%) showed improvement of more than three lines of BCVA at 12 months after treatment. Baseline BCVA (odds ratio (OR), 5.119; 95% confidence interval (CI), 1.993-9.545; P = 0.004), duration of symptoms (OR, 0.727; 95% CI, 0.332-0.952; P = 0.024), hemorrhage area (OR, 0.892; 95% CI, 0.721-0.965; P = 0.011), and baseline central foveal thickness (OR, 0.881; 95% CI, 0.722-0.945; P = 0.032) were significantly associated with good visual acuity 12 months after treatment.

Conclusions: Intravitreal anti-VEGF monotherapy is a valuable treatment option for large SMH secondary to nAMD.

Figures

Figure 1

Changes in mean best-corrected visual acuity (BCVA) and mean central foveal thickness in eyes with large submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD) after treatment. The mean BCVA showed significant improvements during the follow-up period (a), and the mean central foveal thickness (b) also showed significant improvements during the follow-up period (*P<0.05).

Figure 2

Several cases of anti-vascular endothelial growth factor (VEGF) monotherapy for large submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD). a1, Color fundus photography (CFP) showing large SMH; best corrected visual acuity (BCVA) was 10/200. a2, Spectral-domain optical coherence tomography (SD-OCT) showing a thick SMH at the fovea. a3, CFP 12 months after treatment (total number of injections: 3). a4, SD-OCT at 12 months; BCVA recovered to 20/30. b1, Large SMH with a BCVA of 20/200. b2, SD-OCT at baseline showing subfoveal hemorrhage and pigment epithelial detachment (PED). b3, CFP at 12 months showing SMH resolution around the macular area (total number of injections: 5). b4, SD-OCT at 12 months; BCVA recovered to 20/70. c1, Large SMH 28 days after onset; BCVA was 5/200. c2, SD-OCT at baseline shows subfoveal hyperreflective material due to an organized blood clot. c3, CFP at 12 months showed resolved SMH (total number of injections: 4). c4, SD-OCT at 12 months; BCVA recovered to 20/50. d1, CFP showing extensive SMH extending to the mid-periphery with a symptom duration of 14 days; BCVA was finger counting. d2, SD-OCT at baseline showing some hyperreflective material due to an organized blood clot and PED. d3, CFP at 12 months showing complete resolution of SMH (total number of injections: 5). d4. SD-OCT at 12 months; BCVA recovered to 20/70. e1, CFP showing extensive SMH extending to the periphery. e2, SD-OCT at baseline showing a subfoveal organized blood clot; BCVA was 5/200. e3, CFP at 12 months showing much improved SMH (total number of injections: 4). e4, SD-OCT at 12 months; BCVA recovered to 20/30.

Figure 3

Percentages of study participants with improved (gain of ≥3 lines), stable (gain or loss of