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Kamal Kishore, Sachin Jain, Yog R. Sharma, Bharti Kashyap; Disappearance of Drusen after Intravitreal Anti-VEGF Injections for Submacular Hemorrhage (SMH) Secondary To Neovascular Macular Degeneration (n-AMD). Invest. Ophthalmol. Vis. Sci. 2012;53(14):2912.
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To report rapid regression of drusen in 3 eyes with acute SMH secondary to n-AMD treated with anti-VEGF injections.
Retrospective chart review of 3 eyes of 3 patients (age 63,86 and 85 yrs, all F) presenting with central scotoma of ≤ 7 days secondary to SMH from n-AMD. Inclusion criteria: availability of color fundus photos obtained ≤1 year prior to onset of SMH, multiple, large (soft) drusen on those photos, clear media and follow up > one yr. Exclusion criteria: symptoms ≥7days, treatment other than anti-VEGF injections, pre-existing subretinal fibrosis or GA, and non-AMD SMH. After initial work up including IVFA and OCT, monthly injections of bevacizumab 1.25 mg/0.05mL (2 eyes) or 0.5 mg/0.05mL ranibizumab (1 eye) were initiated until resolution of SMH, and less frequently thereafter. Fundus photos obtained after resolution of SMH were compared side-by-side with those prior to onset of SMH for change in soft drusen, and other findings.
Lesion size ranged from 12.2-91 mm2. SMH resolved in all eyes in 4,5 and 11 months respectively without subretinal fibrosis. Marked (>90%) regression of drusen was observed in each eye compared to pre-SMH photos (Figure 1: OD of Case 1 six month prior to SMH. Figure 2: Same eye 4 month after SMH showing resolution of SMH and marked regression of drusen). RPE hypopigmentation, but no GA was also noted in one eye. Occult CNVM was noted in each eye. Final VA improved to 20/30, 20/50 and 20/40 from the baseline of 20/50, HM and CF.
Soft drusen may regress rapidly in patients with SMH treated with anti-VEGF injections, most likely due to phagocytosis of drusen material by macrophages and multinucleated giant cells.
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