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Michelle V. Carle, Homayoun Tabandeh, David S. Boyer, Thomas Chu, Firas Rahhal; Submacular Hemorrhage in Patients with Neovascular AMD Receiving Anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5164.
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In patients with neovascular age-related macular degeneration (nvAMD) severe visual loss may result from submacular hemorrhage (SMH) despite treatment with anti-VEGF agents. The purpose of current study was to evaluate the characteristics and outcomes of patients with nvAMD who develop severe submacular hemorrhage during anti-VEGF therapy.
Retrospective chart review. Inclusion criteria: patients with nvAMD treated with anti-VEGF agents who developed severe submacular hemorrhage.
13 eyes of 12 patients (8 female, 4 male) were included in the study. The mean age was 79 years (range 64 to 98). Anti-VEGF treatment as the last dose prior to hemorrhage was intravitreal bevacizumab in 6 eyes and ranibizumab in 6 eyes, and one eye being referred in from another practice on "anti-VEGF" treatment unspecified. In 10 of the eyes with SMH, the hemorrhage occurred during a drug-free phase or in a period of non-compliance with follow up. The number of treatments prior to development of SMH averaged 4 injections (range 1 to 18). Average interval from last injection to presentation with submacular hemorrhage was 6 weeks (range 1 to 16 weeks) excluding the one patient with a 32 month interval between visits. Prior to submacular hemorrhage the BCVA was 20/70 - 20/100 in 5 eyes; 20/200 in 5 eyes; < 20/200 in 2 eyes; and unknown in one eye. Treatment included continuation of anti-VEGF therapy without other intervention in 4 eyes and pneumatic displacement with or without vitrectomy in 9 eyes. At the last follow up BCVA was 20/100 - 20/200 in 5 eyes, 20/400 in 2 eyes, and < 20/400 in 6 eyes.
Severe submacular hemorrhage during anti-VEGF therapy for nvAMD is an uncommon occurrence and is associated with poor visual outcome. The majority of submacular hemorrhages occurred beyond 6 weeks after a prior anti-VEGF treatment. The findings have implications in discussing compliance with patients and also when considering PRN dosing.
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