Intravitreal Bevacizumab as Primary Therapy of Acute Submacular Hemorrhage Due to Neovascular Age–Related Macular Degeneration

Abstract

 

Purpose:

 

Submacular hemorrhage secondary to neovascular age related macular degeneration (AMD) can inhibit evaluation and treatment of neovascular lesions by limiting visualization. Intravitreous injections of antiangiogenic compounds may be advantageous in this clinical setting as they can inhibit neovascular growth and/or vascular leakage despite limited visualization. This report characterizes the results of intravitreal bevacizumab (Avastin®) as primary therapy in patients with submacular hemorrhage due to AMD.

 

Methods:

 

This is a retrospective case series of patients who presented with acute submacular hemorrhage secondary to AMD. After informed consent, each patient elected to receive intravitreal bevacizumab (1.25 mg) as first–line treatment. All patients received same pre–and post–treatment clinical evaluations including fluorescein angiography, Stratus OCT, and scanning laser ophthalmoscope (SLO) microperimetry. Patients were re–evaluated at one week and one month. Re–injection was considered at one month.

 

Results:

 

Objective clinical measurements are presented in the table below. Three patients have been treated as described above. Patients 1 and 2 were moderately symptomatic at presentation, with subretinal hemorrhages inferior to––but threatening to––the fovea. By contrast, patient 3 was severely symptomatic with a large subfoveal hemorrhage. All three patients reported subjective improvement in vision within one week of treatment. Interestingly, all had subfoveal pigment epithelial detachments (PED) in the affected eye. Patients 1 and 3 recieved two total injections of bevacizumab. Patient 2 recieved one total injection of bevacizumab. No complications were observed.

 

Conclusions:

 

Intravitreal bevacizuab therapy is associated with an improvement in foveal retina thickness in three patients with submacular hemorrhage secondary to AMD. Additional improvements in visual acuity, PED size, and reduction of scotoma size were found in the two patients who did not have subfoveal hemorrhage.  

 

Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: systems/equipment/techniques • growth factors/growth factor receptors