Abstract
Purpose :
To identify baseline characteristics associated with “catastrophic” decline in best corrected visual acuity (VA) secondary to the development of subretinal hemorrhage (SRH) in patients undergoing routine anti-vascular endothelial growth factor (anti-VEGF) treatment for neovascular age-related macular degeneration (nAMD).
Methods :
Electronic health records (EHR) from a single practice between January 1, 2016 and November 1, 2023 were mined with an automated search algorithm to identify eyes that developed SRH during ongoing anti-VEGF therapy for nAMD. Demographic and ocular characteristics were extracted from EHR and optical coherence tomography (OCT) features were recorded. Eyes were divided into two cohorts based on the presence or absence of catastrophic VA loss, defined as >25 letters loss of VA. The “baseline” visit was defined as the visit prior to SRH development. Included eyes received at least one anti-VEGF injection within 6 months of SRH onset. Logistic regression analyses were performed to identify baseline characteristics associated with catastrophic VA loss.
Results :
41 eyes of 39 patients developed SRH during the study period. Of those 41 eyes, 18 (43.9%) experienced catastrophic VA loss (mean -66.1±23.1 letters) while 23 (56.1%) did not (mean -3.2±7.6 letters). On univariate analysis, longer duration of anti-VEGF therapy (adjusted odds ratio [aOR] 1.03, 95% confidence interval [95% CI], 1.01-1.06, p = 0.019) and presentation at interval shorter than the average treatment interval over prior three visits (aOR 11.429, 95% CI, 2.49-52.51, p = 0.002) were found to be significantly associated with catastrophic BCVA loss. Both remained significant on multivariate testing. No association was found between SRH-related catastrophic VA loss and the use of systemic anti-coagulant or anti-platelet medications, or a history of systemic hypertension. Additionally, no association was found with anti-VEGF drug choice or baseline OCT parameters including the presence of intra- or subretinal fluid or central subfield thickness.
Conclusions :
Longer duration of anti-VEGF therapy and presentation within typical prior treatment interval may be associated with greater risk of catastrophic VA loss secondary to NVAMD-related SRH during anti-VEGF therapy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.