Abstract
Purpose To study long-term clinical outcomes in patients with submacular hemorrhage (SMH) and/or vitreous hemorrhage (VH) associated with neovascular age-related macular degeneration (nAMD) and the real-world clinical situation of adding anti-VEGF therapy after pars plana vitrectomy (PPV). Methods In this retrospective case series, 25 eyes with SMH and/or VH associated with nAMD were treated by PPV and followed up for at least 24 months. When exudative changes were unresolved or recurred after PPV, additional intravitreal anti-VEGF therapy was given. Results The reasons for performing PPV were SMH (8 eyes) and VH (17 eyes) associated with nAMD. Mean best-corrected visual acuity (BCVA) of eyes with SMH improved significantly at 6 months (P < 0.01) and 12 months (P < 0.05) after PPV. Mean BCVA of eyes with VH improved at 1, 3, 6, 12, 18, and 24 months (P < 0.01) and at the final visit (P < 0.05). Post-PPV anti-VEGF therapy was initiated in 6 of 8 (75.0%) eyes with SMH and 7 of 17 (47.1%) eyes with VH. Of the 13 eyes given anti-VEGF therapy after PPV, 11 eyes had anti-VEGF therapy initiated within 10 months after surgery. Dry macula rate after PPV was 50.0% in SMH and 70.6% in VH. Conclusions BCVA improved in eyes with SMH at 6 and 12 months after PPV, and the BCVA was maintained until the end of the study. BCVA improved significantly in eyes with VH at all time points after PPV. In eyes undergoing PPV for nAMD, recurrence of exudative changes after 11 months from the initial PPV was rare.
Highlights
Antivascular endothelial growth factor (VEGF) therapy is the first-line therapy for neovascular age-related macular degeneration, and sometimes pars plana vitrectomy (PPV) is required in highly active cases with submacular hemorrhage (SMH) or vitreous hemorrhage (VH)
We investigated the long-term outcome and the real-world clinical situation of additional anti-VEGF therapy after PPV
TPA was injected into the subretinal space in 8 eyes with SMH and in 5 eyes with VH
Summary
Antivascular endothelial growth factor (VEGF) therapy is the first-line therapy for neovascular age-related macular degeneration (nAMD), and sometimes pars plana vitrectomy (PPV) is required in highly active cases with submacular hemorrhage (SMH) or vitreous hemorrhage (VH). While PPV may reduce the activity of nAMD [8, 9], unresolved or recurrent exudative changes may require addition of anti-VEGF therapy even after PPV. 2. Materials and Methods is study was a retrospective case series of consecutive patients with nAMD complicated by SMH or VH, who were treated with PPV and followed up for at least 24 months after. E patients were examined for best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, OCT examination, and fluorescein and indocyanine green angiography before the initial PPV (baseline). Intravitreal injection of anti-VEGF agents was performed after PPV for unresolved or recurred exudative changes detected using an ophthalmoscope or by OCT. The treat and extend (TAE) regimen [19, 20] was used for subsequent injections depending on the activity of nAMD while receiving anti-VEGF therapy.
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