Intravitreal Bevacizumab for Neovascular Age Related Macular Degeneration With Large Submacular Hemorrhage

Abstract

Purpose: : To evaluate the efficacy and safety of intravitreal bevacizumab for the management of neovascular age-related macular degeneration (AMD) with large submacular hemorrhage.

Methods: : Consecutive interventional case series of 8 eyes (8 patients) with recent (range 1-3 weeks) and large submacular hemorrhage associated with occult choroidal neovascularization (CNV) secondary to AMD. All patients were followed-up for at least 12 months. Patients were treated with one or more intravitreal bevacizumab injections (1.25mg/0.05ml). Follow-up visits were planned every 4 to 6 weeks. Retreatment was based on the presence of metamorphopsia and fluid on optical coherence tomography (OCT). Changes in best corrected visual acuity (BCVA), central retinal thickness (OCT) and hemorrhage size were assessed.

Results: : At 6 months, BCVA improved three or more Snellen lines in 5 eyes (62.5%) and remained stable in 3 eyes (37.5%). Similar results were achieved at 12 months. Mean central retinal thickness was 590.24µm at baseline and decreased significantly to 388.2µm at 6 months (p<0.01) and to 250.6µm (p<0.01) at 12 months. Mean size of hemorrhage was significantly reduced from 12mm at baseline to 1.5 mm at 6 months (p <0.01). Hemorrhage completely resolved in 4 eyes (50%) at 6 months. Mean number of injections was 3.3 at 12 months. No ocular or systemic complications were observed.

Conclusions: : The one-year outcomes suggest intravitreal bevacizumab alone to be an efficient and safe treatment for eyes with neovascular AMD and large submacular hemorrhages, resulting in rapid functional and anatomical improvements. Further long term studies are required to confirm these findings.

Keywords: retina • age-related macular degeneration • choroid: neovascularization