Intravitreal anti-vascular endothelial growth factor monotherapy for large submacular hemorrhage secondary to neovascular age-related macular degeneration

Purpose

To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) monotherapy for large submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD).

Methods

A total of 49 treatment-naive patients (49 eyes) with large SMH (more than five disc areas (DAs)) secondary to nAMD were retrospectively included. All patients were treated with an initial series of 3 monthly intravitreal anti-VEGF injections, followed by as-needed injections. At the 12-month follow-up, changes in best-corrected visual acuity (BCVA), hemorrhage area, central foveal thickness, and development of vitreous hemorrhage after treatment were evaluated.

Results

The mean SMH area was 13.9±8.8 disk areas (DAs) and mean symptom duration was 7.25±5.9 days at baseline. The mean number of injections was 4.49±1.61. Twelve months after treatment, the mean BCVA significantly improved from 1.14±0.61 logarithm of the minimum angle of resolution (logMAR; 20/276, Snellen equivalent) to 0.82±0.53 logMAR (20/132; P=0.002). Twenty-four eyes (49%) showed improvement of more than three lines of BCVA at 12 months after treatment. Baseline BCVA (odds ratio (OR), 5.119; 95% confidence interval (CI), 1.993–9.545; P=0.004), duration of symptoms (OR, 0.727; 95% CI, 0.332–0.952; P=0.024), hemorrhage area (OR, 0.892; 95% CI, 0.721–0.965; P=0.011), and baseline central foveal thickness (OR, 0.881; 95% CI, 0.722–0.945; P=0.032) were significantly associated with good visual acuity 12 months after treatment.

Conclusions

Intravitreal anti-VEGF monotherapy is a valuable treatment option for large SMH secondary to nAMD.