title: Occurrence of macular hematoma after ranibizumab treatment for age-related macular degeneration.
abstract: OBJECTIVE
  To report the occurrence and study the characteristics of macular hematoma after ranibizumab (anti-VEGF) intravitreal injection for subfoveal choroidal neovascularization in age-related macular degeneration (AMD).
  
  
  METHODS
  The charts of 6000 patients treated with ranibizumab (0.5 mg) for exudative AMD were reviewed. Inclusion criteria were a minimum follow-up of 1 year after the first injection and the occurrence of a large macular hematoma involving the fovea in patients with macular lesions considered stabilized or still active. All patients had a complete ophthalmologic assessment including Early Treatment of Diabetic Retinopathy Study visual acuity (VA) measurement, fundus photography, fundus fluorescein angiography, scanning laser ophthalmoscopy-infracyanine green angiography, and spectral-domain optical coherence tomography.
  
  
  RESULTS
  Of the 6000 eyes, 24 (0.4%) developed macular hematoma during follow-up. There were 8 men (33.3%) and 16 women (66.7%). The mean age at the time of initial presentation was 76.7 ± 3.8 years (range 61-81 years). The mean time to occurrence of macular hematoma after the last injection was 4.8 months. Spectral-domain optical coherence tomography showed the presence of a retinal pigment epithelium (RPE) tear in 19 eyes (79.1%). Vitreomacular traction (VMT) was only present in 4 eyes (17%). Final VA after macular hematoma resorption was &lt;20/50 in 17 cases (70.9%) and ≥20/50 in 7 cases (29.1%).
  
  
  CONCLUSIONS
  Macular hematoma may follow intravitreal anti-VEGF injection for exudative AMD with large occult neovascularization, especially if a large RPE tear is found. The occurrence does not seem to be linked to anticoagulation treatment or the presence of VMT.
authors: Eye & Ear University Hospital, Université Saint-Esprit de Kaslik, Université Saint-Joseph, Beirut - Lebanon.
authors: Georges
authors: G
authors: Azar
authors: Martine
authors: M
authors: Mauget-Faÿsse
authors: Jasmine
authors: J
authors: Nyouma
authors: Salomon Yves
authors: SY
authors: Cohen
authors: Florence
authors: F
authors: Coscas
authors: Catherine
authors: C
authors: Français-Maury
authors: Eric
authors: E
authors: Souied
authors: Gisèle
authors: G
authors: Soubrane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006406:Hematoma / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007208:Indocyanine Green / Q000031:analogs & derivatives; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D000069579:Ranibizumab; D012166:Retinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D041623:Tomography, Optical Coherence / Q000379:methods; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D004396:Coloring Agents; C116320:Infracyanine green; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007208:Indocyanine Green; D000069579:Ranibizumab