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G. Prigione, A. Polito, S. Degli Esposti, B. Parolini, G. Pertile; Surgical Treatment of Large Submacular Hemorrhages After Intravitreal Bevacizumab for Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5965. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the functional outcome of surgical treatment of large submacular hemmorrhages (SMHs) after intravitreal bevacizumab for choroidal neovascularization (CNV).
A prospective, interventional case series on 13 patients with large SMHs secondary to sub-foveal CNV occurring within one month after intravitreal Bevacizumab. In 5 patients vitreous hemorrhage was also present and 1 patient had a serous-hemorrhagic retinal pigment epithelium (RPE) detachment. Preoperative visual acuity ranged from Light Perception to logMar 0,6. In 9 patients a full macular translocation (FMT) with 360 degree retinotomy was performed, 3 underwent an autologous RPE and choroid transplantation with 180 degree peripheral retinotomy and in one patient a 360 degree retinotomy was carried out. The surgical choice depended upon the diameter of the neovascular lesion, presence of healthy RPE and visual acuity of the fellow eye. A complete eye exam including best corrected visual acuity, dilated slit lamp biomicroscopy and colour fundus photograph was performed at baseline and at 1 week, 1 month and every three months thereafter. Fluorescein and ICG angiography and OCT were performed at each visit based on the visibility of the fundus. Follow up ranged between 4 and 21 months (median = 7).
88% (11) of patients had improvement (8) or stabilisation (3) of visual acuity. A complete removal of the SMH and of the neovascular lesion was obtained in all patients. No complications occurred during and after surgery. The full thickness patch of autologous RPE appeared flat, brown and well centered under the fovea in two patients, one had a wrinkled nasal margin. Furthermore, one patient after FMT had a progressive visual acuity reduction caused by an enlarging area of RPE atrophy involving the new fovea.
As the majority of patients had vision improvement or stabilisation, surgical removal of large SMHs with concomitant excision of the neovascular complex can be considered an effective approach in case of subretinal hemmorrages after intravitreal Bevacizumab for CNV. Further evaluations are necessary to determine which patients will have the most benefit from this therapeutic method.
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