June-Gone Kim, Sung Jae Yang, Jong Uk Hwang, Soo Geun Joe, Joo Yong Lee (Seoul, South Korea)


To describe the clinical characteristics and risk factors of recurrent, submacular hemorrhage in AMD.


We reviewed the medical records of the neovascular AMD patients showing submacular hemorrhage at their onset. The required minimum follow-up period was 24 months, and any newly developed, submacular hemorrhage larger than one disc area after near-complete resolution of the initial submacular hemorrhage, was defined as recurrent submacular hemorrhage. Clinical characteristics assessed in the study were visual acuity at both the initial and the last follow-up visit, size of the initial submacular hemorrhage, the presence of polypoidal choroidal vasculopathy (PCV), and procedures (intraocular surgery/intravitreal intravitreal injection/PDT) during the follow-up period.

Effectiveness / Safety:

A total 47 eyes in 47 patients were eligible for the analysis. 24 patients showed recurrent submacular hemorrhage (Group I). Patients without recurrent submacular hemorrhage were defined as Group II. The total follow-up duration was 37.1 months in Group I and 36.4 months in Group II. (P = 0.823) The time until recurrent submacular hemorrhage in Group I was 21.4 months (CI [17.5, 25.3]). The presence of diabetes/hypertension, use of anti-platelet agents/anticoagulants, visual acuity at the initial and last visit, size of the initial submacular hemorrhage, and PDT/intraocular surgery / intravitreal gas or triamcinolone acetonide injection was not statistically different in the two groups. PCV was present in 50% of Group I  (n = 12) and in 13% of Group II (n = 3) (P = 0.025). Intravitreal anti-VEGF injection during follow-up period was performed in 70.8% of Group I (n = 17) and in 95.7% of Group II (n = 22) (P = 0.048).

Take home message:

In patients with neovascular AMD presenting as submacular hemorrhage, the incidence of recurrent submacular hemorrhage was 51.1% in our long-term, follow-up study. Intravitreal anti-VEGF injection was related to lowering the recurrence of submacular hemorrhage and the presence of PCV was strongly associated with the recurrence of submacular hemorrhage.