Korean J Ophthalmol.  2015 Oct;29(5):315-324. 10.3341/kjo.2015.29.5.315.

Clinical Outcomes of Eyes with Submacular Hemorrhage Secondary to Age-related Macular Degeneration Treated with Anti-vascular Endothelial Growth Factor

• Kim KH
• Kim JH
• Chang YS
• Lee TG
• Kim JW
• Lew YJ

• KMID: 2363805
• DOI: http://doi.org/10.3341/kjo.2015.29.5.315

Abstract

PURPOSE
To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with submacular hemorrhage secondary to exudative age-related macular degeneration.
METHODS
This retrospective, observational study included 49 patients (49 eyes) who initially presented with submacular hemorrhage associated with exudative age-related macular degeneration and who were followed-up for at least 24 months. Only eyes that were treated with intravitreal anti-VEGF monotherapy were included in the study. Best-corrected visual acuity (BCVA) measurements obtained at diagnosis, six months, and the final visit were compared. The associations of BCVA at the final visit with baseline BCVA, BCVA at six months, symptom duration, hemorrhage extent, and central foveal thickness were also analyzed.
RESULTS
Over the course of follow-up (mean, 32.1 +/- 8.5 months), an average of 5.1 +/- 2.2 anti-VEGF injections were administered. Recurrent hemorrhage was noted in 13 eyes (26.5%). The mean logarithm of the minimal angle of resolution BCVA at diagnosis, six months, and the final visit were 1.40 +/- 0.52, 0.87 +/- 0.64, and 1.03 +/- 0.83, respectively. Both baseline BCVA (p = 0.012) and BCVA at six months (p < 0.001) were significantly associated with BCVA at the final visit.
CONCLUSIONS
Improved visual acuity was maintained for more than two years with intravitreal anti-VEGF monotherapy. BCVA at six months is a useful clinical index to predict long-term visual prognosis.

Keyword

Anti-vascular endothelial growth factor; Exudative age-related macular degeneration; Long-term outcome; Polypoidal choroidal vasculopathy; Submacular hemorrhage

MeSH Terms

Aged
Aged, 80 and over
Angiogenesis Inhibitors/administration & dosage
Bevacizumab/*administration & dosage
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Intravitreal Injections
Male
Middle Aged
Ranibizumab/*administration & dosage
Retina/*diagnostic imaging
Retinal Hemorrhage/diagnosis/*drug therapy/etiology
Retrospective Studies
Time Factors
Tomography, Optical Coherence
Treatment Outcome
Vascular Endothelial Growth Factor A/*antagonists & inhibitors
Visual Acuity
Wet Macular Degeneration/complications/diagnosis/*drug therapy
Angiogenesis Inhibitors
Bevacizumab
Ranibizumab
Vascular Endothelial Growth Factor A

Figure

• 

  Fig. 1 Fundus photography and optical coherence tomography findings of an eye with submacular hemorrhage secondary to polypoidal choroidal vasculopathy. At the time of diagnosis, visual acuity was measured as 20 / 100 (A,B). At 6 months, the hemorrhage had resolved completely, and visual acuity had improved to 20 / 25 (C,D). The eye was treated with 5 ranibizumab injections during the 28-month follow-up period. At 28 months, visual acuity was maintained at 20 / 25 (E,F).

• 

  Fig. 2 Changes in the mean logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) among eyes that received anti-vascular endothelial growth factor monotherapy for submacular hemorrhage secondary to exudative age-related macular degeneration, according to the follow-up period. (A) In all 39 eyes, BCVA at the final visit was significantly better than baseline BCVA (p = 0.012). The difference between BCVA at the final visit and BCVA at six months or 12 months was not significant (p = 0.156 and 0.113, respectively). (B) Changes in values when the patients were divided into two groups according to diagnosis. Solid line (closed circles) indicates eyes diagnosed with typical exudative age-related macular degeneration (n = 15); dashed line (closed squares) indicates eyes diagnosed with polypoidal choroidal vasculopathy (n = 31).

• 

  Fig. 3 A timetable showing the timing of recurrences of fovea-involving submacular hemorrhage according to the follow-up period. Inverted triangles indicate the first recurrence. Asterisks indicate the second recurrence. Fifteen recurrences were noted in 13 eyes. Two eyes experienced two episodes of recurrence.

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