Intravitreal anti‐VEGF in submacular hemorrhage due to age related macular degeneration

Abstract

AbstractPurpose To evaluate efficacy and prognostic factors of intravitreal anti‐VEGF for large submacular hemorrhage (HSM) secondary to age‐related macular degeneration (AMD).Methods Eighteen eyes of 18 patients with HSM neovascular AMD were reviewed. HSM had to respect a diameter greater than three papillary disk diameters and with fovea participation. Visual acuity was considered at diagnosed and when best final visual acuity was achieved. HSM outcomes were measured by SD‐OCT. Statistical analysis was used to evaluate association between visual acuity and different outcomes: macular status of fellow eye, hemorrhagic surface, hemorrhage localization, central foveal thickness, highest macular thickness and macular volume.Results Mean duration of symptoms was 25.94 +/‐ 32 days. Mean anti‐VEGF injection was 3.31 +/‐ 0.3. Mean hemorrhagic surface was 8.77 +/‐ 6.52 disc areas. 62 % patients presented their first exudative episode. The mean logMAR visual acuity improved from 1.5 +/‐ 0.52 to 1.0 +/‐ 0.40 at final examination (p=0.04). A gain of three EDTRS lines or more was found in 50% patients. No association was evident between opposite side status, hemorrhagic surface and initial central fovea thickness with final visual acuity. Although an association between highest macular thickness, macular volume (p 0.05) and final visual acuity was significant. Patients with predominant sub‐retinal pigment epithelial hemorrhage seemed to have a worst visual prognosis.Conclusion Anti‐VEGF therapy is a useful treatment for large HSM. In our study, highest macular thickness and macular volume at diagnosis seem more predictive than central fovea thickness or hemorrhagic surface. Factor prognosis need to be clearly identify to select patients for surgical procedures.