Comparison of treatment methods for submacular hemorrhage in neovascular age-related macular degeneration: conservative versus active surgical strategy

Abstract

The optimal treatment of submacular hemorrhage (SMH) following neovascular age-related macular degeneration (nAMD) is controversial. This study aimed to compare visual outcomes of conservative versus active surgical treatment. Two hundred thirty-six eyes of 236 patients with SMH (≥ 1 disc diameter) were stratified into four groups: observation (n = 21); anti-vascular endothelial growth factor (VEGF) monotherapy (n = 161); non-surgical gas tamponade (n = 31); and subretinal surgery (n = 23). The primary outcome was best-corrected visual acuity (BCVA) at 12 months. The baseline BCVAs of the observation, anti-VEGF monotherapy, non-surgical gas tamponade, and subretinal surgery groups were 1.50 ± 0.70, 1.09 ± 0.70, 1.31 ± 0.83, and 1.62 ± 0.77 logarithm of minimal angle resolution (LogMAR), respectively. The mean BCVAs at 12 months were 1.39 ± 0.84, 0.90 ± 0.83, 1.35 ± 0.88, and 1.44 ± 0.91 LogMAR, respectively. After adjusting for age, baseline BCVA, SMH size, and the number of intravitreal anti-VEGF injections before SMH, the mean BCVA showed no significant difference among treatments at 12 months (P = 0.204). The anti-VEGF monotherapy group showed better mean BCVA significantly at 3 months (P < 0.001). Only baseline BCVA was associated with VA gain at 12 months (Odds ratio = 3.53, P < 0.001). This study demonstrated that there was no difference in 12 month visual outcomes among treatments and a better early visual outcome can be expected with anti-VEGF monotherapy.

Figure 1

The visual outcomes in eyes treated for submacular hemorrhage secondary to neovascular age-related macular degeneration according to each treatment strategy. (A) The trend of best-corrected visual acuity (BCVA). (B) The trend of BCVA change from baseline. LogMAR, logarithm of the minimum angle of resolution; M, months.

Figure 2

The subgroup anaylsis based on baseline best-corrected visual acuities (BCVA). (A) Poor: Baseline BCVA ≥ 2.0 LogMAR (Baseline BCVA ≤ 20/400). (B) Intermediate: 1.0 LogMAR ≤ Baseline BCVA < 2.0 LogMAR (20/400 < Baseline BCVA ≤ 20/200). (C) Good: Baseline BCVA < 1.0 LogMAR (Baseline BCVA > 20/200). LogMAR, logarithm of the minimum angle of resolution; M, months.

Figure 3

The subgroup anaylsis by the size of submacular hemorrhage. (A) Size of submacular hemorrhage ≤ 4 disc diameter. (B) Size of submacular hemorrhage > 4 disc diameter. LogMAR, logarithm of the minimum angle of resolution; M, months.

Figure 4

Rate of loss or gain of visual acuity. (A) Gain of ≥ 3 lines (B) Loss of ≥ 3 lines. VEGF, vascular endothelial growth factor.

Figure 5

Logistic regression model for gain of ≥ 3 lines in visual acuity at 12 months after treatment. VEGF, vascular endothelial growth factor; BCVA, best-corrected visual acuity.