[Subretinal hemorrhage after intravitreal injection of anti-VEGF for age-related macular degeneration: a retrospective study].
BACKGROUND
Prescription of anti-VEGF treatments have increased substantially over the past few years in treatment of wet age-related macular degeneration. We report the occurrence of macular hemorrhages after one year of use of anti-VEGF intravitreal injections, mainly for subfoveal choroidal neovascularization.


METHODS
Four hundred forty five injections were given over one year (from 15 March 2007 to 15 March 2008), for age-related macular degeneration, retinal vascular occlusion, diabetic retinopathy, neovascular glaucoma, and idiopathic macular choroidal neovascularization; distributed as follows: 11.5% Bevacizumab, 18.6% Pegaptanib, 19.3% Triamcinolone, and 50.6% Ranibizumab.


RESULTS
Six macular hemorrhages were observed, resulting in to a sharp decrease in visual acuity (20/400), with loss of five lines. All occurred after one injection of nonselective anti-VEGF (Ranibizumab) on already treated eyes (four previous injections on average, +/- photodynamic therapy). All were secondary to occult choroidal neovascularization or a large pigment epithelial detachment. Three patients presented a pigment epithelial tear.


CONCLUSIONS
Anti-VEGF intravitreal injections can lead to pigment epithelial tears in case of large pigment epithelial detachment, especially with a small feeder vessel or with large occult choroidal neovascularization. The authors discuss the possible implications of anti-VEGF when macular hematoma occurs: retraction of choroidal neovascularization and alteration of physiological retinal vascularization.


CONCLUSIONS
Macular hematoma affects visual prognosis in age-related macular degeneration. It may follow intravitreal anti-VEGF injection with large occult neovascularization, especially in previously treated eyes. Injection in large pigment epithelial detachment may cause a risk of epithelial tear. Other studies are necessary to evaluate the role of the nonselective anti-VEGF in the incidence of macular hematoma.
Baeteman
C
C
Service d'ophtalmologie, Hôpital de Vision, Timone, Marseille. christophebaet@aol.com
Hoffart
L
L
Galland
F
F
Ridings
B
B
Conrath
J
J
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D012166:Retinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
D042461:Vascular Endothelial Growth Factor A