Jean-François Le Rouic, Frank Becquet, Didier Ducournau (Nantes, France)

Introduction: 

Although anti-VEGF therapy is a breakthrough in the treatment of exudative age-related macular degeneration (ARMD), sub-macular haemorrhage remains a major concern which may still need surgical treatment when the bleeding is large and thick.  We wondered if the main characteristics and the outcome of patients presenting with sub-macular hematoma due to ARMD in the anti-VEGF era differs from those observed previously.

Patients and Method: 

A group of 51 patients operated consecutively for sub-macular hematoma due to ARMD between November 2006 and February 2010 was compared with a group of 47 patients operated between January 2004 and March 2006.  Analyzed data included demographic characteristics,  anti-aggregant or anti-coagulant treatment intake, high blood pressure; ASA classification, preoperative visual acuity, duration and extent of the haemorrhage, previous treatment on the interested eye, any pathology on the fellow eye, visual outcome, re-bleeding, and additional treatment on the interested eye within 6 months.

Results: 

In the anti-VEGF era group, patients were older (mean age: 80 +/- 7 years old, vs 77 +/- 6; p = 0.02), the interested eye had more often been treated for ARMD before bleeding (55% vs 28%; p = 0,007); and had more often additional ARMD treatment postoperatively (88% vs 46%; p < 0,001).  The extent of the sub-retinal haemorrhage was also greater.  No significant difference was noted when comparing the rate of re-bleeding (20% vs 13%); or the postoperative visual acuity.

Discussion: 

Our results reflect the possibility of treating early phases of exudative ARMD with anti-VEGF injection.  This treatment can be proposed for minimal sub-macular bleeding which is no longer a surgical indication.  However, large sub-macular hematomas are still currently seen in our practice.  Despite anti-VEGF treatment, the postoperative visual outcome of sub-macular hematoma due to ARMD is poor and the risk of re-bleeding has not decreased.