Original article
Shortest Distance From Fovea to Subfoveal Hemorrhage Border Is Important in Patients With Neovascular Age-related Macular Degeneration

https://doi.org/10.1016/j.ajo.2018.02.015Get rights and content

Purpose

To identify factors influencing visual outcome in patients with neovascular age-related macular degeneration (NVAMD) and subfoveal hemorrhage (SFH) treated with anti–vascular endothelial growth factor (VEGF) agents.

Design

Retrospective case series.

Methods

Anti-VEGF-treated eyes with SFH > 1 disc area (DA) were identified (n = 16) and changes in visual acuity (VA) and central subfield thickness (CST) from baseline to last follow-up, along with SFH area, thickness, minimum distance from fovea to SFH border, and time to resolution, were determined.

Results

At baseline, mean (± standard error of the mean) size and thickness of SFH were 14.9 ± 2.8 DA and 386.6 ± 46.9 μm, and mean Snellen VA and CST were 20/250 and 591.7 ± 57.0 μm. Median follow-up was 47.6 months. While more than 50% of patients had VA ≤ 20/200 at baseline and all time points through week 48, the percentage of patients with VA ≥ 20/50 increased to 30%–40% at months 6 and 12 and remained stable through month 48. Spearman rank correlation demonstrated 2 independent variables that correlated with good visual outcome, smaller area of SFH at baseline (r = −0.630; P = .009), and high frequency of anti-VEGF injections (r = 0.646; P = .007). In exceptional patients with good visual outcome despite large baseline SFH, shortest distance between the fovea and hemorrhage border significantly correlated with baseline VA (r = −0.503, P = .047) and final VA (r = −0.575, P = .02).

Conclusions

Patients with NVAMD and thick SFH, but short distance between fovea and uninvolved retina, can have good visual outcomes when given frequent anti-VEGF injections.

Section snippets

Methods

This was a retrospective, observational case series conducted at a single center (The Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA). The protocol was approved by Institutional Review Board of the Johns Hopkins Medical Institutions and was conducted in accordance with the Declaration of Helsinki. Initial screening was done to identify patients with NVAMD seen by one of the authors between January and December 2014. All records of these patients are from the first time

Patient Disposition

A total of 265 eyes of 222 patients with a diagnosis of NVAMD were seen by 1 of the co-authors at the Wilmer Eye Institute between January and December 2014 and all images and records of those patients prior to and after 2014 were evaluated. Thirty-five eyes of 34 patients had subretinal hemorrhage (13.2%), out of which 19 eyes of 18 patients were excluded for the following reasons: 7 eyes of 7 patients had subretinal hemorrhage not involving the fovea, 8 eyes of 7 patients had SFH < 1 DA, 2

Discussion

Compared to prior industry-sponsored clinical trials investigating anti-VEGF agents for NVAMD, the inclusion of B50 patients in CATT has provided greater guidance for treatment of NVAMD patients with subretinal blood. There was no significant difference in visual or anatomic outcomes in the 84 B50 patients compared with 1101 patients in the other category suggesting that a larger area of subretinal blood within the CNV lesion complex does not adversely affect outcomes of anti-VEGF treatment.

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