Silvia Bopp, Andreas Schüler, Klaus Lucke (Bremen, Germany)

Advantages: 

To investigate the role of sub-retinal hemorrhages in exudative ARMD and investigate, if the hemorrhagic component influences the outcomes under continuous anti-VEGF therapy.

Methods:

Retrospective chart review of 30 patients presenting with exudative ARMD and concurrent sub-retinal hemorrhage of 2 disc diameters, who were treated with ranibizumab or bevacizumab monotherapy according to the current recommendations (3x monthly upload and retreatment upon requirement).  AMD with spotty hemorrhages, mostly due to RAP lesions were excluded as well as eyes with previous treatment for ARMD.

Outcome measures: 

Visual acuity, number of anti-VEGF injections, FFA and OCT findings and adverse events, such as retinal pigment epithelium tear and re-bleeding.

Effectiveness / Safety:

Thirteen percent (30/241) of newly referred patients presented with exudative ARMD and concomitant hemorrhages.  Mean follow-up was 30 weeks with 3.5 injections given.  Blood most often reabsorbed within 3 – 5 months.  Pre-treatment VA was 0.19 (range: 0.03-0.4) and improved to 0.24 (range 0.02-0.8).  Vision remained unchanged in 44.4%, improved in 33.3% and deteriorated in 22.2%.  Limited outcomes were associated with advanced non-responding CNV and resulted in discontinuation of further injections.

Take home message:

We found that in this cohort most eyes responded well in terms of hemorrhagic reabsorption and resolution of macular edema / exudate.  Thus, anti-VEGF monotherapy is effective for this subgroup as well.  However, compared to exudative AMD without hemorrhagic component, functional outcome appears to be worse.