Macular hemorrhage in neovascular age-related macular degeneration after stabilization with antiangiogenic therapy.
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.
Levine
Jonathan P
JP
Albert Einstein College of Medicine, Bronx, New York, USA.
Marcus
Inna
I
Sorenson
John A
JA
Spaide
Richard F
RF
Cooney
Michael J
MJ
Freund
K Bailey
KB
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
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab