Intravitreal anti-vascular endothelial growth factor for submacular hemorrhage from choroidal neovascularization

Ophthalmology. 2014 Apr;121(4):926-35. doi: 10.1016/j.ophtha.2013.11.004. Epub 2013 Dec 15.


Purpose: To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with exudative age-related macular degeneration (AMD) accompanied by submacular hemorrhage.

Design: Retrospective, observational case series.

Participants: Ninety-one eyes of 91 patients who initially presented with submacular hemorrhage associated with exudative AMD from October 2009 to September 2012. Patients were followed up for at least 6 months after treatment.

Methods: Best-corrected visual acuity (BCVA) was measured at diagnosis and at 1, 3, and 6 months after treatment. The duration of symptoms was estimated. The extent of hemorrhage was estimated using fundus photography, and central foveal thickness was measured using optical coherence tomography. Change in BCVA during 6 months after treatment was estimated. The correlation of BCVA at 6 months with duration of symptoms, extent of hemorrhage, and central foveal thickness was evaluated.

Main outcome measures: The BCVA, duration of symptoms, extent of hemorrhage, and central foveal thickness.

Results: The mean duration of symptoms was 27.6±39.5 days. The mean extent of hemorrhage was 7.8±5.6 disc areas, and the mean central foveal thickness was 610.1±249.6 μm. All eyes were treated with 3.2±0.8 (range, 1-5) monthly intravitreal anti-VEGF injections during the 6-month follow-up period. The logarithm of the minimum angle of resolution BCVA at diagnosis and at 1, 3, and 6 months after the initial diagnosis was 1.38±0.53 (Snellen equivalent, 20/479), 1.27±0.57, 1.05±0.58, and 0.96±0.65 (Snellen equivalent, 20/182), respectively. The BCVA at 6 months significantly improved from baseline (P < 0.001). Poor BCVA at 6 months correlated with a longer duration of symptoms, greater extent of hemorrhage, and greater central foveal thickness (P = 0.008, P = 0.004, and P = 0.014, respectively).

Conclusions: Anti-VEGF monotherapy was found to be a useful treatment option for exudative AMD accompanied by submacular hemorrhage. However, the limited efficacy in eyes with large hemorrhage may suggest the need for more aggressive treatment in these cases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use*
  • Choroidal Neovascularization / complications
  • Choroidal Neovascularization / drug therapy
  • Choroidal Neovascularization / physiopathology
  • Coloring Agents
  • Exudates and Transudates
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Humans
  • Indocyanine Green
  • Intravitreal Injections
  • Male
  • Middle Aged
  • Retinal Hemorrhage / drug therapy*
  • Retinal Hemorrhage / etiology
  • Retinal Hemorrhage / physiopathology
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Visual Acuity / physiology
  • Wet Macular Degeneration / complications
  • Wet Macular Degeneration / drug therapy*
  • Wet Macular Degeneration / physiopathology


  • Angiogenesis Inhibitors
  • Coloring Agents
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Indocyanine Green