Impact of treatment gap on visual acuity in patients with submacular hemorrhage secondary to neovascular age-related macular degeneration treated with quadruple intervention strategy.

BACKGROUND

Submacular hemorrhage (SMH) is an uncommon complication of neovascular age-related macular degeneration (AMD).

OBJECTIVES

The study aim was to evaluate the efficacy of combination therapy vitrectomy with subretinal recombinant tissue plasminogen activator (rtPA) given under the retina and anti-VEGF given into the vitreous cavity in patients with SMH based on duration of symptoms and to identify biomarkers to help predict potential visual acuity gain after the procedure.

DESIGN

Retrospective case series.

METHODS

Patients with SMH secondary to AMD were treated with quadruple therapy: (1) vitrectomy; (2) rtPA administration; (3) bevacizumab injection into the vitreous cavity; followed by (4) monthly intravitreal double-dose bevacizumab 2.5 mg.

RESULTS

Forty-eight patients were treated (68.8% women; mean age, 80 years). A median of 14 days elapsed between SMH onset and surgical intervention (range, 2-120 days), with vitrectomy performed after ⩾30 days in 39.6% of patients. A significant improvement from baseline in mean best-corrected visual acuity (BCVA) was observed 6 months after SMH treatment (1.6 (baseline) vs 0.9 (Month 6) logMAR; p < 0.001). Overall, 46 (95.8%) patients had improved BCVA and two (4.2%) had stable (unchanged) BCVA in the treated eye. Improvement in BCVA at Month 6 was similar between the cohort with only SMH and patients with coexisting subretinal pigment epithelium hemorrhage (p = 0.11). The main biomarkers predicting surgical outcome were the state of the retina in the foveal center point and hemorrhage thickness. Treatment ⩾30 days after SMH onset resulted in poorer BCVA at Month 6 compared with treatment occurring <30 days after onset (p < 0.05).

CONCLUSION

A combination of vitrectomy, subretinal rtPA, and bevacizumab, performed in patients with submacular hemorrhage due to neovascular AMD, followed by monthly intravitreal double-dose bevacizumab for SMH, was an effective intervention to achieve visual acuity improvement.