Abstract
Objective: The study aimed to determine the outcomes and prognostic factors of vitrectomy, subretinal injection of tissue-plasminogen activator and gas tamponade in macular hemorrhage (MaH) due to age-related macular degeneration (AMD) or retinal arterial macroaneurysm (RAM). Methods: The study design utilized a multicentric retrospective case series design of consecutive patients undergoing surgery between 2014 and 2019. Results: A total of 65 eyes from 65 patients were included in the study. Surgery was performed after a mean period of 7.1 days. Displacement of MaH was achieved in 82% of the eyes. Mean best-corrected visual acuity (BCVA) improved from 20/500 to 20/125 at month(M)1 and M6 (p < 0.05). At M6, BCVA worsening was associated with an older age at diagnosis (p = 0.0002) and higher subretinal OCT elevation of MaH (p = 0.03). The use of treat and extend (TE) (OR = 16.7, p = 0.001) and small MaH fundus size (OR = 0.64 and 0.74 for horizontal and vertical fundus size, p < 0.05) were predictive of a higher likelihood of obtaining a countable BCVA at M1. Baseline BCVA was predictive of postoperative BCVA (p < 0.05). Retinal detachment and MaH recurrence occurred in 3% and 9.3% of cases at M6. Conclusion: MaH surgery stabilizes or improves BCVA in 85% of cases. Younger age at diagnosis, better baseline BCVA figures, smaller subretinal MaH height and use of TE regime were predictive of the best postoperative outcomes.
Highlights
Macular hemorrhage (MaH) is a serious and blinding complication of several pathologies, the most frequent being age-related macular degeneration (AMD)
Contrary to several previous studies addressing the same topic [8,9], we found that the height of the subfoveal subretinal portion of macular hemorrhage (MaH) was correlated with the final best corrected visual acuity (BCVA)
We found in contradiction with others, that baseline BCVA was linearly correlated with BCVA value at 1 and 6 months, independent of lens status since the majority of eyes were pseudophakic by M6 (Tables 2 and 3)
Summary
This was a multicenter retrospective observational clinical case series of consecutive patients recruited in three tertiary retina care units between December 2014 and December 2019, namely Lariboisière University Hospital, Paris, France, Puerta de HierroMajadahonda University Hospital, Madrid, Spain and the University of British Columbia, Vancouver, Canada. Consecutive adult patients with neovascular AMD or RAM complicated by macular hematoma (MaH) (size on funduscopy > 1.5 disc diameter) and managed surgically (see paragraph) were included. (OCT)BBBscans scanspassing passingby bythe thefoveal fovealcenter, center,representing representingthe theleft lefteye eyeof ofan an8181year-old female presenting with macular hematoma consecutive to type-1 choroidal neovascularization due to age related year-old year-oldfemale femalepresenting presentingwith withmacular macularhematoma hematomaconsecutive consecutivetototype-1 type-1choroidal choroidalneovascularization neovascularizationdue duetotoage agerelated related maculardegeneration. B-scan, subretinal portion of the hemorrhage are represented with white arrows. When larger than the scale of the OCT B-scan, subretinal portion of the hemorrhage are represented with white arrows. Picture taken months after surgery, showing complete displacement of the hematoma, the development of fibrotic lesions (white asterisks,**) at the level of the preoperative hemorrhage andatrophy atrophythe ofthe thephotoreceptor photoreceptor layer.The. Thepost-operative post-operative scan obtained asof reference forthe the displacement of the and hematoma, development of fibrotic lesions Postoperative antiVEGF was administered monthly for at least 6 months (Ranibizumab 0.5 mg, Lucentis® , Novartis, Germany, or Aflibercept 2 mg, Eylea® , Bayer, Germany)
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