title: Macular hemorrhage in neovascular age-related macular degeneration after stabilization with antiangiogenic therapy.
abstract: OBJECTIVE
  To study patients with neovascular age-related macular degeneration (AMD) who experienced a macular hemorrhage after stabilization with intravitreal antivascular endothelial growth factor (anti-VEGF) agents to improve current treatment regimens and prevent disease progression.
  
  
  METHODS
  Retrospective chart review of six patients. The main outcome measures included time between last intravitreal anti-VEGF treatment and date of hemorrhage, time between last office visit and date of hemorrhage, and visual acuity before and after hemorrhage.
  
  
  RESULTS
  Three of 6 eyes had a macular hemorrhage within 4 weeks of a stable examination. One eye had optical coherence tomography (OCT) that demonstrated no fluid 1 day before the macular hemorrhage. The average time between the date of the last injection and macular hemorrhage was 16.8 weeks (range, 7.3-28.9 weeks). The average time between the last stable examination and an event was 4.2 weeks (range, 1 day to 7.3 weeks). Three of six patients had a persistent decline in vision after the hemorrhage. Among the 4 patients, who had better than 20/200 vision before the macular hemorrhage, 2 dropped to 20/200 or worse.
  
  
  CONCLUSIONS
  Sight-threatening macular hemorrhages from AMD can occur within days to weeks after a stable examination and absence of fluid on OCT. Regimens that treat "as needed" based on clinical findings and OCT may not be appropriate for certain patients.
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Levine
authors.forename: Inna
authors.initials: I
authors.lastname: Marcus
authors.forename: John A
authors.initials: JA
authors.lastname: Sorenson
authors.forename: Richard F
authors.initials: RF
authors.lastname: Spaide
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cooney
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000187:drug effects / Q000503:physiopathology; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D012166:Retinal Hemorrhage / Q000209:etiology*; D015861:Retinal Neovascularization / Q000188:drug therapy; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab