Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration

Background: To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy. Methods: This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed. Results: Mean baseline VA was 0.15plusminus0.2 and 0.25plusminus0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1plusminus0.14; P=0.003), and a stabilization in group B (mean difference: +0.008plusminus0.2; P=0.94). CRT decreased significantly by 70 mum in group A (P=0.001) and by 84 mum in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm2 and 19.1 mm2 at baseline and 0.0 mm2 and 2.0 mm2 at month 4, respectively. The anti-VEGF treatmentrate was 1.6 in group A and 3.0 in group B. Conclusion: In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss