Combined Anti-VEGF and C3F8 Injection for Large Submacular Hemorrhage Secondary to Age-Related Macular Degeneration

Young Lee Min; Moon Seo Won; Je Choi Yul

doi:10.3341/jkos.2013.54.3.443

Journal List > J Korean Ophthalmol Soc > v.54(3) > 1009618

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Min, Won, and Yul: Combined Anti-VEGF and C3F8 Injection for Large Submacular Hemorrhage Secondary to Age-Related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2007;54(3):443-448.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.3.443

Combined Anti-VEGF and C₃F₈ Injection for Large Submacular Hemorrhage Secondary to Age-Related Macular Degeneration

Young Lee Min, MD¹, Moon Seo Won, MD^1,, Je Choi Yul, MD²

¹Department of Ophthalmology, Dongkang Medical Center, Ulsan, Korea

²Myung Eye Clinic, Ulsan, Korea

Address reprint requests to Won Moon Seo, MD Department of Ophthalmology, Dongkang Medical Center #239 Taehwa-ro, Jung-gu, Ulsan 681-711, Korea Tel: 82-52-241-1331, Fax: 82-52-241-1146, E-mail: mdseowm@msn.com

Received 26 July 2006 Accepted 8 May 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of intravitreal expansile gas (C₃F₈) with anti-VEGF injection for the treatment of large submacular hemorrhage (SMH) secondary to age-related macular degeneration (ARMD).

Methods

In this report, 18 eyes of 18 patients with large SMH secondary to ARMD were treated with a simultaneous injection of 0.3 cc C₃F₈ and 0.05 ml anti-VEGF intravitrealy.

Results

The mean age was 64.89 ± 5.68 years and the mean size of SMH was 4.44 ± 1.25 disc diameters (DD). The minimum follow-up period was 12 months (range: 12-17 months). Mean preoperative best corrected visual acuity (BCVA) was 1.72 ± 0.56 log MAR which improved significantly to 1.01 ± 0.68 log MAR at 12 months (p = 0.002). SMH displacement occurred in all eyes. BCVA improved 2 or more lines in 11 eyes (61.1%) and deteriorated in 1 eye (5.6%).

Conclusions

In this report, intravitreal injection of an expansible gas (C₃F₈) with anti-VEGF produced successful results in anatomical displacement of SMH and early visual improvement.

Keywords: Age-related macular degeneration, Anti-VEGF, C₃F₈ gas, Submacular hemorrhage

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Figure 1.

Color photograph (A), fluorescein angiography (B) and optical coherence tomography (C) of case 1 before treatment. Postoperative 3 days after intravitreal C3F8 and anti-VEGF injection (D). On 12 months, color photograph (E) and optical coherence tomography (F).

Figure 2.

Mean visual acuity changes from baseline through 12 months. ^*VA = visual acuity; ^†M = month.

Table 1.

Patient's characteristics

Case	Sex/age	Anticoagulation	Anti-platelet	Visual acuity (log MAR)		Duration of Symptoms (day)	Size of SMH (disc diameter)	Number of anti-VEGF injection	Complications
Case	Sex/age	Anticoagulation	Anti-platelet	Visual acuity (log MAR)		Duration of Symptoms (day)	Size of SMH (disc diameter)	Number of anti-VEGF injection	Complications	Baseline	12 months
1	M/63	-	+	2	1.7	1	3	5	IIOP
2	F/65	-	-	1.9	1	2	4	5	IIOP
3	M/58	-	-	1	0.4	1	3	3	RD
4	F/74	+	+	2.4	2.4	3	7	5	IIOP, Vitreous Hmr
5	F/70	-	-	1.6	0.7	1	4	7	-
6	F/67	-	-	2	1.6	3	4	5	-
7	M/64	-	-	1.9	1	4	3	7	IIOP
8	M/64	-	-	1.7	0.9	2	4	8	-
9	M/72	+	+	2.1	2.1	4	5	7	Disciform scar
10	F/53	-	-	1	0.8	5	3	3	-
11	M/67	+	+	2	0.3	1	4	7	-
12	M.66	-	-	1	1	7	6	5	Vitreous Hmr
13	M/68	+	-	1.1	0.3	5	7	5	Vitreous Hmr
14	F/72	-	-	1.2	2	10	5	8	-
15	M/56	-	-	1.1	0	7	4	6	-
16	M/64	-	-	2	0.4	3	4	6	-
17	F/68	+	-	3	1	4	5	7	-
18	M/58	-	-	2	0.7	4	5	5	-

SMH = submacular hemorrhage; IIOP = increased intraocular pressure; RD = retinal detachment; Hmr = hemorrhage.

Table 2.

Changes in visual acuity

	Visual acuity (mean ± SD, log MAR)	p-value (difference from baseline)	p-value (difference from Prior VA)
Prior to injection	1.72 ± 0.56
1 week after injection	1.20 ± 0.41	0.000^*	0.000
1 month after injection	0.99 ± 0.49	0.000^*	0.011
3 months after injection	1.00 ± 0.57	0.001^*	0.286
6 months after injection	0.99 ± 0.65	0.002^*	0.480
12 months after injection	1.02 ± 0.67	0.002^*	0.914

^* Wilcoxon signed ranks test.

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