June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Anti-Vascular Endothelial Growth Factor Monotherapy for Thick Submacular Hemorrhage Associated With Retinal Pigment Epithelial Detachment in Age-Related Macular Degeneration
Author Affiliations & Notes
  • Jeffrey G Gross
    Carolina Retina Center, Columbia, South Carolina, United States
  • Freda Yin
    Carolina Retina Center, Columbia, South Carolina, United States
  • W. Riley Stroman
    University of South Carolina School of Medicine, Columbia, South Carolina, United States
  • Footnotes
    Commercial Relationships   Jeffrey Gross, Acucela (F), Genentech (F), Ohr Pharmaceuticals (F), Regeneron (F); Freda Yin, None; W. Riley Stroman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 417. doi:
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    • Get Citation

      Jeffrey G Gross, Freda Yin, W. Riley Stroman; Anti-Vascular Endothelial Growth Factor Monotherapy for Thick Submacular Hemorrhage Associated With Retinal Pigment Epithelial Detachment in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):417.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Thick submacular hemorrhage in age-related macular degeneration (AMD) is often managed by vitrectomy with pneumatic displacement using injected tissue plasminogen activator (TPA) and/or air into the subretinal space. Retinal pigment epithelial detachment (PED) beneath the subretinal hemorrhage may pose risks associated with the subretinal injection. A retrospective, observational clinical study was performed to assess the efficacy of anti-vascular endothelial growth factor (anti-VEGF) injections for the treatment of thick submacular hemorrhages associated with retinal PED complicating AMD.

Methods : Retrospective consecutive case series of six eyes with AMD and acute onset thick submacular hemorrhage associated with underlying retinal PED and vision loss. Eyes received intravitreal anti-VEGF monotherapy using bevacizumab, ranibizumab or aflibercept every 4 weeks. After resolution of the subfoveal hemorrhage component the interval was extended using a treat and extend schedule.

Results : Optical coherence tomography (OCT) central thickness of the subretinal hemorrhage was greater than 450 microns in each eye at baseline (range 467 – 1177 microns). All eyes demonstrated resolution of the subfoveal portion of submacular hemorrhage between 3 to 4 months. Snellen visual acuity at baseline ranged between 20/100 and 2/200 (mean 20/567). Maximum Snellen visual acuity ranged from 20/25 to 20/400 (mean 20/143) and 67% were 20/50 or better. Following a minimum follow up of 4 months (range 4 - 47 months) the final visual acuity ranged from 20/30 to 20/400 (mean 20/156). Complications included subfoveal RPE atrophy 1 eye and an RPE tear in one eye. None of the eyes had recurrent subretinal hemorrhage, injection related complications or endophthalmitis.

Conclusions : Anti-VEGF monotherapy resulted in improved visual and anatomic outcomes and may be an effective treatment alternative to vitrectomy with pneumatic displacement for submacular hemorrhage associated with retinal PED complicating AMD.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Thick submacular hemorrhage. Vision 5/100, OCT 770 micron thickness.

Thick submacular hemorrhage. Vision 5/100, OCT 770 micron thickness.

 

Submacular hemorrhage resolved after anti-VEGF monotherapy. Vision 20/25, OCT 276 micron thickness.

Submacular hemorrhage resolved after anti-VEGF monotherapy. Vision 20/25, OCT 276 micron thickness.

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