Predicting Visual Outcome in Patients with Neovascular Age-related Macular Degeneration Presenting with Subfoveal Hemorrhage

Authors: Brian Chue. 
Author Disclosure Block: B. Chue: None.

Purpose: To identify factors affecting outcome in patients with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV), presented with subfoveal hemorrhage (SFH) treated with anti-vascular endothelial growth factor (VEGF) injections. 

Study Design: Retrospective case series. 

Methods: 264 eyes with diagnosis of nAMD treated by anti-VEGF injections were evaluated in a two-year period (1 July 2018 to 30 June 2020) retrospectively. 17 eyes with SFH > 1 disc area (DA) were analyzed, which 5 of them were PCV patients. The remaining eyes were excluded due to absence of subretinal hemorrhage, subretinal hemorrhage not involving the fovea or treatment other than anti-VEGF injection during follow up for nAMD. Patient demographics, imaging characteristics such as SFH area and thickness, minimum distance from fovea to SFH border, and clinical assessment such as visual acuity (VA) and central subfield thickness (CST) from baseline to last follow up were noted.

Results: Interestingly, size of subfoveal hemorrhage did not correlate with visual outcome. But Spearman rank correlation showed larger area of SFH correlated with longer duration (P = 0.007) and more injections (P = 0.02) before resolution. Short distance from fovea center to hemorrhage border (P = 0.024), younger patient (P = 0.017) and PCV group (P = 0.005) had better visual acuity at the time of SFH resolution.

Conclusions: More time and more injections were required if patients have a larger subfoveal hemorrhage. Unfortunately, the visual outcome of the older nAMD patient remained poor regardless.