Anti-vascular endothelial growth factor monotherapy in the treatment of submacular hemorrhage secondary to polypoidal choroidal vasculopathy

Am J Ophthalmol. 2013 Sep;156(3):524-531.e1. doi: 10.1016/j.ajo.2013.04.029. Epub 2013 Jun 13.

Abstract

Purpose: To evaluate the effect of intravitreal anti-vascular endothelial growth factor (VEGF) injections on submacular hemorrhage secondary to polypoidal choroidal vasculopathy.

Design: Retrospective, interventional case series.

Methods: Twenty-seven eyes from 27 polypoidal choroidal vasculopathy patients with submacular hemorrhage involving the fovea were included in the analyses. All patients were treated by anti-VEGF injection with an initial 3 loading injections by month, followed by an as-needed reinjection. Visual acuity, central macular thickness, submacular hemorrhage size, and the occurrence of vitreous hemorrhage were examined during a 12-month follow-up period.

Results: The mean number of injections administered over the course of 12 months was 3.59 ± 1.04. The size of submacular hemorrhages averaged 18.2 ± 13.8 mm². The mean logarithm of the minimal angle of resolution (logMAR) visual acuity at baseline was 1.02 ± 0.51 (Snellen equivalent, 20/204) and improved significantly to 0.76 ± 0.48 (Snellen equivalent, 20/115) at 12 months (P = .02). Mean central macular thickness decreased from 311.7 ± 124.5 μm at baseline to 246.8 ± 102.8 μm at 12 months (P = .01). At 12 months, visual acuity improved by 0.3 logMAR or more in 10 eyes (37%), stabilized (change between 0 and 0.3 logMAR) in 11 eyes (40.7%), and decreased by 0.3 logMAR or more in 6 eyes (22.2%). Three eyes (11.1%) were subjected to vitrectomy to clear a vitreous hemorrhage that occurred after anti-VEGF therapy.

Conclusions: Intravitreal anti-VEGF injection monotherapy may be a valuable therapeutic option in treating eyes with submacular hemorrhage associated with polypoidal choroidal vasculopathy.

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Bevacizumab
  • Choroid / blood supply*
  • Choroid Diseases / complications*
  • Choroid Diseases / diagnosis
  • Coloring Agents
  • Combined Modality Therapy
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Fluorescein Angiography
  • Humans
  • Indocyanine Green
  • Intravitreal Injections
  • Macula Lutea / pathology
  • Male
  • Middle Aged
  • Photochemotherapy
  • Polyps / complications*
  • Polyps / diagnosis
  • Ranibizumab
  • Retinal Hemorrhage / drug therapy*
  • Retinal Hemorrhage / etiology
  • Retrospective Studies
  • Tissue Plasminogen Activator / therapeutic use
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Visual Acuity / physiology
  • Vitreous Hemorrhage / diagnosis

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Coloring Agents
  • Fibrinolytic Agents
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Bevacizumab
  • Tissue Plasminogen Activator
  • Indocyanine Green
  • Ranibizumab