Actuality:

In most cases, the period and the gradual reduction of visual acuity in AMD allows patients to adapt to low vision without a sudden loss of central vision and independence. In case of a massive subretinal hemorrhage on the basis of AMD, patients experience sudden loss of central vision and the associated debasement in the quality of life. A-VEGF therapy in the treatment of subretinal hemorrhage, appears ambiguous. Changes in visual acuity during treatment depends on the initial amount of blood under the retina.

Purpose:

To determine the advisability of A-VEGF therapy for the treatment of wet AMD with various sizes subretinal hemorrhages.

Materials & Methods:

Retrospective analysis of OCT data, visual acuity and ophthalmoscopy of treatment results by intravitreal A-VEGF injection (IVI) in 22 eyes with fresh various sizes sub retinal hemorrhage on the background of wet AMD was performed. The diagnosis was confirmed by OCT and ophthalmoscopy data of damaged and the paired eyes. Dynamic analysis of OCT,  funds photography and visual acuity was carried out in group I – with subretinal hemorrhage with an area of less than 1 disc diameter(DD) (8 eyes), group II – with hemorrhage area from 1 to 3 DD (10 eyes) and in group III – with massive subretinal hemorrhage beyond the retinal vascular arcades (4 eyes). Patients’ age – from 65 to 83 years. The course of treatment was 1 IVI in group III. In groups I and II 3 monthly IVI of ranibizumab was performed.

Results & Discussions:

Morphological retinal changes Table 1 Morphological fundus changes Group I (8 eyes) Group II (10 eyes) Group III (4 eyes) Number of eyes (%) Reduction of subretinal hemorrhage height according to OCT data 8 eyes (100%) 10 eyes (100%) 3 eyes (75%) Hemophthalmia after IVI – 1 eye (10%) 4 eyes (100%) Detection of pigment epithelium rupture during the treatment – 9 eyes (90%) – Complete resorption of subretinal blood – 8 (100%) –  Subretinal blood organization – 10 eyes (100%) 4 eyes (100%) From the data presented in the Table 1 it follows that in all examined eyes of group I under Ranibizumab treatment the complete subretinal blood resorption with the restoration of macular zone anatomy was present. In patients of group II in the macular zone there was a partial organization of subretinal blood. In the majority of cases during the treatment pigment epithelium rupture was detected. Treatment of patients of group III did not progress to  subretinal blood resorption, it was organized in massive clots. In addition, in all patients of the 3rd group under A-VEGF therapy total hemophthalmus, requiring surgery (vitrectomy) developed. Visual acuity dynamics in examined patients Table 2 Examination period Group I (8 eyes) Group II (10 eyes) Group III (4 eyes) Average visual acuity with correction Before treatment 0.4 0.3 0.05 After treatment 0.7 0.15 0.05 The patients’ visual acuity in group I after treatment improved up to a full recovery, in the group II vision slightly decreased despite the subjective improvement in quality of vision. Functional results of patients in group III were not changed.

Conclusions: 

In patients with wet AMD, complicated by subretinal hemorrhage in the macula with an area of up to 1 DD, under ranibizumab treatment the restoration of visual function and macular zone anatomy was observed. Visual acuity in patients with hemorrhage from 1 to 3 DD under  treatment can be reduced due to the formation of pigment epithelium rupture (PER), but even with PER development, patients reported subjective improvement in the quality of vision, because of the complete or partial subretinal blood resorption. To perform A-VEGF therapy in patients with massive hemorrhage under the retina beyond the vascular arcades is impractical because hemorrhage resorption is insignificant and visual acuity does not improve. In addition, there is a high risk of hemophthalmia with decreased visual acuity and the need for vitrectomy.

Contact Details:

Email: elena_eyedoc@mail.ru
Cell Phone: +79184525233