Korean J Ophthalmol.  2018 Oct;32(5):361-368. 10.3341/kjo.2017.0095.

Development of Submacular Hemorrhage in Neovascular Age-related Macular Degeneration: Influence on Visual Prognosis in a Clinical Setting

• Chang YS
• Kim JH
• Kim JW
• Kim CG
• Lee DW

• KMID: 2422065
• DOI: http://doi.org/10.3341/kjo.2017.0095

Abstract

PURPOSE
This study aimed to evaluate changes in visual acuity before and after the development of submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD) and to compare the visual outcomes between patients with and without hemorrhage.
METHODS
This retrospective observational study included 124 patients with neovascular AMD. Patients who developed a submacular hemorrhage involving the fovea were included in the hemorrhage group (n = 55). Patients with no sign of submacular hemorrhage during the follow-up period were included in the no-hemorrhage group (n = 69). Visual outcomes were compared between the two groups.
RESULTS
The logarithm of the minimal angle of resolution best-corrected visual acuity (BCVA) before the development of submacular hemorrhage, once the hemorrhage had developed, and 6 months after the development of hemorrhage was 0.59 ± 0.45, 1.24 ± 0.57, and 0.99 ± 0.64, respectively. BCVA was significantly worse 6 months after the hemorrhage compared to before the hemorrhage (p < 0.001). The BCVA before the development of hemorrhage (measured at a mean of 12.9 months after diagnosis) was comparable to that of the no-hemorrhage group (mean, 0.58 ± 0.37 at a mean of 12.4 months). However, the BCVA 6 months after identification of hemorrhage (mean, 21.5 months) was significantly worse in the hemorrhage group than in the no-hemorrhage group (mean, 0.73 ± 0.44 at mean 21.2 months) (p = 0.018).
CONCLUSIONS
Visual acuity was significantly worse after hemorrhage than before hemorrhage, even after treatment. In addition, patients with submacular hemorrhage had markedly worse visual outcomes than patients without hemorrhage. This result suggests that the development of hemorrhage during the treatment course of neovascular AMD has a devastating effect on visual prognosis.

Keyword

Anti-vascular endothelial growth factor; Choroidal neovascularization; Hemorrhage; Macular degeneration; Polypoidal choroidal vasculopathy

MeSH Terms

Choroidal Neovascularization
Follow-Up Studies
Hemorrhage*
Humans
Macular Degeneration*
Observational Study
Prognosis*
Retrospective Studies
Visual Acuity

Figure

• 

  Fig. 1 Images taken (A,B) at diagnosis, (C) once the hemorrhage had developed, and (D) 6 months after the development of hemorrhage in patient diagnosed with polypoidal choroidal vasculopathy. The best-corrected visual acuity measured at each time point was 20 / 100, 20 / 200, and 20 / 200, respectively. (A,C,D) Fundus photography and (B) indocyanine green angiography.

• 

  Fig. 2 Changes in the logarithm of the minimal angle of resolution best-corrected visual acuity (BCVA) in eyes with (hemorrhage group; solid line, closed circles, n = 55) and without submacular hemorrhage (no-hemorrhage group; dashed line, closed squares, n = 69), according to follow-up. In the hemorrhage group, the mean BCVA at initial diagnosis, at the first time point, after development of hemorrhage (arrow), and at the second time point was 0.56 ± 0.42, 0.59 ± 0.45, 1.24 ± 0.57, and 0.99 ± 0.64, respectively. In the no-hemorrhage group, the mean BCVA at initial diagnosis, at the first time point, and at the second time point was 0.60 ± 0.37, 0.58 ± 0.37, and 0.73 ± 0.44, respectively. The BCVA at the first time point was comparable between the two groups (p = 1.000, independent-samples t-test with Bonferroni's correction). However, the BCVA at the second time point was significantly worse in the hemorrhage group than in the no-hemorrhage group (*p = 0.018, independent-samples t-test with Bonferroni's correction). Each time point was defined as follows: baseline, once neovascular age-related macular degeneration was diagnosed; first, the first time point; and second, the second time point. logMAR = logarithm of the minimal angle of resolution.

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