Visual and anatomical outcomes in NVAMD patients with subfoveal hemorrhage (SFH) treated with anti-VEGF agents

Abstract

Purpose : To assess visual and anatomic outcomes in patients with NVAMD complicated by SFH treated with intraocular injections of anti-VEGF agents.

Methods : Screening of patients with NVAMD seen by a co-author between January and December 2014 identified 222 (265 eyes) with good follow up; 15 patients had SFH ≥1 disc area (DA) in one eye treated with injections of an anti-VEGF agent.

Results : Baseline visual acuity (VA) was 20/50-20/100, 20/125-20/160, 20/200-20/400, or ≤20/500 in 2, 2, 8, 3 patients. The number of patients with final VA ≥20/40, 20/50-20/100, 20/125-20/160, 20/200-20/400, or ≤20/500 was 2, 3, 1, 3, 6. Change from baseline VA at final visit was a gain ≥3, ≥2, ≥1 lines in 4, 5, 7, no change in 3, and loss of ≥3, ≥2, ≥1 lines in 4, 4, 4 patients. The duration between anti-VEGF injections was 4-6 weeks in 6, relatively frequent PRN in 2, and PRN with long treatment-free intervals in 7 patients. Two (13.3%) patients developed subfoveal (SF) atrophy without fibrosis and 8 (53.3%) developed SF fibrosis, 5 out of which developed atrophy within the area of fibrosis during follow-up.
Patients receiving frequent injections (every 4-6 weeks; n=6) had VA gain >3 lines in 2, gain of 1-3 lines in 2, no change in 1 and loss of 1-3 lines in 1; received 20.5±4.8 injections over a mean of 26.6±7.8 months, and developed SF fibrosis in 2, SF atrophy in 1 and neither in 3. Those receiving PRN injections with long intervals without treatment (n=7) had VA gain >3 lines in 1, 1-3 lines in 1, no change in 2 and loss of >3 lines in 3; received 10.7±2.6 injections over mean duration of 40.0±4.4 months and developed SF fibrosis in 71.4% and SF atrophy in 28.6%.
Patients who developed SF fibrosis or atrophy (n=10) versus those that did not (n=5) had mean SRH size of 13.3±2.0 vs 4.3±1.7 DA, received 9.8±1.8 vs 23.8±4.4 anti-VEGF injections over a mean of 31.7±5.4 vs 32.8±6.5 months; had a VA gain >3 lines in 10.0% vs 60.0%, 1-3 lines in 10.0% vs 40.0%, no change in 30.0% vs 0, loss of 1-3 lines 10.0% vs 0, loss of >3 lines in 40.0% vs 0.

Conclusions : SFH does not preclude good visual outcomes in patients with NVAMD and there is an association of good outcomes with smaller area of SFH and more frequent anti-VEGF injections.

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