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Abstract
Purpose
To evaluate the effects of intravitreal aflibercept injection in the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD).
Methods
This retrospective, observational study included patients diagnosed with nAMD with submacular hemorrhage treated with intravitreal aflibercept monotherapy. A total of 54 eyes of 54 patients were treated with an initial series of three monthly intravitreal aflibercept injections followed by as-needed injections. At the 6 month follow-up, changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and submacular hemorrhage area (SMH) were evaluated.
Results
The mean preoperative BCVA was 0.79 ± 0.59 logMAR, which improved significantly to 0.53 ± 0.46 logMAR at 3 months and 0.48 ± 0.50 logMAR at 6 months (p<0.001, in both). The CMT significantly decreased in all eyes: preoperative, 454.4 ± 131.5 µm, to 242.6 ± 39.7 µm at 6 months. The SMH was also reduced in all eyes: preoperative, 6.4 ± 4.8 disc areas (DAs) to 0.8 ± 1.4 DAs at 6 months. Ten eyes were diagnosed with typical nAMD (18.5%) and 44 eyes were diagnosed polypoidal choroidal vasculopathy (81.5%). There was no significant difference at 6 months in the visual outcomes of the subgroups.
Figures and Tables
Figure 1
Changes in the mean logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) during follow-up period after aflibercept injection. BCVA improved at 3 months and 6 months from baseline. *Statistical analysis performed using repeated measures analysis of variance (ANOVA).
Figure 2
Changes in central macular thickness (CMT) (µm) of eyes received aflibercept monotherapy for submacular hemorrhage secondary to neovascular age-related macular degeneration, according to the follow-up period. The CMT was reduced at 3 months and 6 months from baseline. *Statistical analysis performed using repeated measures analysis of variance (ANOVA).
Figure 3
Changes in the extent of submacular hemorrhage (disc areas) during follow-up period after aflibercept injection. The extent of submacular hemorrhage areas reduced at 3 months and 6 months from baseline. *Statistical analysis performed using repeated measures analysis of variance (ANOVA).
Figure 4
Color fundus photographs and optical coherence tomography (OCT) images of a case of submacular hemorrhage secondary to neovascular age-related macular degeneration treated with intravitreal aflibercept injection. (A) Color photograph at presentation. (B) OCT at presentation. (C) Color photograph at 3 months follow-up. (D) OCT at 3 months follow-up. (E) Color photograph at 6 months follow-up. (F) OCT at 6 months follow-up. The reduction of submacular hemorrhage was observed after intravitreal aflibercept injection.
Table 3
Characteristics of patients into 2 groups according to the diagnosis: typical neovascular age-related macular degeneration (typical nAMD) and polypoidal choroidal vasculopathy (PCV)
Values are presented as mean ± SD or n (%) unless otherwise indicated.
BCVA = best-corrected visual acuity; logMAR = logarithm of minimal angle of resolution; hmr = hemorrhage; CMT = central macular thickness; F/U = follow-up; RPE = retinal pigment epithelium.
*Statistical analysis performed using paired t-test for continuous variables; †Statistical analysis performed using χ2 test for categorical variables.
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