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Danny Mammo, Prethy Rao, Ashkan Abbey, Yoshihiro Yonekawa, Tarek S Hassan; Breakthrough vitreous hemorrhage in neovascular age-related macular degeneration: Prognostic indicators and surgical outcomes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1071.
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© ARVO (1962-2015); The Authors (2016-present)
Vitreous hemorrhage (VH) is a rare but visually significant complication of neovascular AMD. Few studies have examined the prognosis of such eyes. We conducted an interventional retrospective case series of consecutive patients undergoing pars plana vitrectomy (PPV) for VH associated with neovascular AMD and report long-term prognosis and potential predictive factors.
Nineteen patients were included (mean age 81.4 years). Best corrected visual acuity (BCVA) and optical coherence tomography findings at the first visit, day of breakthrough VH and two prior visits, post-operative month 1, and final visit were recorded. Findings in fellow eyes were also recorded. The Wilcoxon signed-rank test was used for nonparametric paired analyses.
Mean time to breakthrough VH was 4.2 years from the initial visit. An average of 4.4 anti-VEGF injections were performed prior to breakthrough bleed. Of 16 patients with documented visits prior to the VH, 11 (69%) exhibited decline from baseline visual acuity (VA) with a mean VA decrease of 4.2 Snellen lines (P=0.02) at the visit immediately before the VH, compared to the visit prior. None of these patients had subretinal hemorrhage or worsening of subretinal fluid on that immediate visit prior to the VH. After PPV, mean LogMAR VA improved from 2.0 preoperatively to 1.6 at the final visit (P=0.01). Mean post-operative follow-up was 120 weeks.
Vitrectomy for breakthrough VH caused by neovascular AMD can improve long-term visual acuity. A decline in VA at the immediately prior visit, even without new hemorrhage or worsening of fluid, may be a risk factor for subsequent breakthrough bleeding.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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