Skip to main content
SpringerLink
Log in

Influence of submacular hemorrhage at baseline on the long-term outcomes of aflibercept treatment for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the influence of submacular hemorrhage (SMH) at baseline on long-term visual outcomes of patients with typical age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV) treated with intravitreal aflibercept (IVA).

Methods

In this retrospective study, eyes of treatment-naïve patients with tAMD and PCV who initiated IVA under a treat-and-extend regimen and were followed up for ≥ 5 years were classified into the tAMD-SMH ( +), tAMD-SMH (-), PCV-SMH ( +), and PCV-SMH (-) groups based on the presence of SMH at baseline. Best-corrected visual acuity (BCVA) changes and macular fibrosis and atrophy incidences were assessed.

Results

This study included 127 eyes (127 patients), including 51 with tAMD and 76 with PCV; 18 eyes had SMH at baseline. In the tAMD-SMH ( +) group (n = 6), the mean logMAR BCVA significantly deteriorated from 0.59 ± 0.45 at baseline to 0.88 ± 0.47 at the final visit (P = 0.024). No significant BCVA changes were observed in the tAMD-SMH (-) (n = 45), PCV-SMH ( +) (n = 12), or PCV-SMH (-) (n = 64) groups (all P > 0.05). The tAMD-SMH ( +) group showed a significantly higher incidence of macular fibrosis at the final visit than did the tAMD-SMH (-) group (P = 0.042). There was no influence of baseline SMH on the macular fibrosis incidence in eyes with PCV and the macular atrophy incidence in eyes with tAMD and PCV.

Conclusion

The presence of SMH at baseline resulted in poorer long-term visual acuity in eyes with tAMD, even with aflibercept treatment. However, no such influence was observed in eyes with PCV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data analyzed during this study are available upon reasonable request to the corresponding author.

References

  1. Altaweel MM, Daniel E, Martin DF et al (2015) Outcomes of eyes with lesions composed of >50% blood in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Ophthalmology 122:391-398.e5. https://doi.org/10.1016/j.ophtha.2014.08.020

    Article  PubMed  Google Scholar 

  2. Mehta A, Steel DH, Muldrew A et al (2022) Associations and outcomes of patients with submacular hemorrhage secondary to age-related macular degeneration in the IVAN trial. Am J Ophthalmol 236:89–98. https://doi.org/10.1016/j.ajo.2021.09.033

    Article  CAS  PubMed  Google Scholar 

  3. Inoue N, Kato A, Araki T et al (2022) Visual prognosis of submacular hemorrhage secondary to age-related macular degeneration: a retrospective multicenter survey. PLoS ONE 17:e0271447. https://doi.org/10.1371/journal.pone.0271447

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kim JH, Kim CG, Lee DW et al (2020) Intravitreal aflibercept for submacular hemorrhage secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 258:107–116. https://doi.org/10.1007/s00417-019-04474-0

    Article  CAS  PubMed  Google Scholar 

  5. Kim JH, Chang YS, Kim JW et al (2014) Intravitreal anti-vascular endothelial growth factor for submacular hemorrhage from choroidal neovascularization. Ophthalmology 121:926–935. https://doi.org/10.1016/j.ophtha.2013.11.004

    Article  PubMed  Google Scholar 

  6. Heier JS, Brown DM, Chong V et al (2012) Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 119:2537–2548. https://doi.org/10.1016/j.ophtha.2012.09.006

    Article  PubMed  Google Scholar 

  7. Rosenfeld PJ, Brown DM, Heier JS et al (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431. https://doi.org/10.1056/NEJMoa054481

    Article  CAS  PubMed  Google Scholar 

  8. Lorentzen TD, Subhi Y, Sørensen TL (2018) Prevalence of polypoidal choroidal vasculopathy in white patients with exudative age-related macular degeneration: systematic review and meta-analysis. Retina 38:2363–2371. https://doi.org/10.1097/IAE.0000000000001872

    Article  PubMed  Google Scholar 

  9. Saito M, Iida T, Saito K et al (2021) Long-term characteristics of exudative age-related macular degeneration in Japanese patients. PLoS ONE 16:e0261320. https://doi.org/10.1371/journal.pone.0261320

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sawada T, Yasukawa T, Imaizumi H et al (2023) Subtype prevalence and baseline visual acuity by age in Japanese patients with neovascular age-related macular degeneration. Jpn J Ophthalmol 67:149–155. https://doi.org/10.1007/s10384-023-00981-0

    Article  CAS  PubMed  Google Scholar 

  11. Cheung CMG, Lee WK, Koizumi H et al (2019) Pachychoroid disease. Eye 33:14–33. https://doi.org/10.1038/s41433-018-0158-4

    Article  PubMed  Google Scholar 

  12. Yamashiro K, Yanagi Y, Koizumi H et al (2022) Relationship between pachychoroid and polypoidal choroidal vasculopathy. J Clin Med Res 11. https://doi.org/10.3390/jcm11154614

  13. Kimura S, Morizane Y, Hosokawa MM et al (2019) Outcomes of vitrectomy combined with subretinal tissue plasminogen activator injection for submacular hemorrhage associated with polypoidal choroidal vasculopathy. Jpn J Ophthalmol 63:382–388. https://doi.org/10.1007/s10384-019-00679-2

    Article  CAS  PubMed  Google Scholar 

  14. Hosokawa M, Morizane Y, Hirano M et al (2017) One-year outcomes of a treat-and-extend regimen of intravitreal aflibercept for polypoidal choroidal vasculopathy. Jpn J Ophthalmol 61:150–158. https://doi.org/10.1007/s10384-016-0492-7

    Article  CAS  PubMed  Google Scholar 

  15. Shin K-H, Lee TG, Kim JH et al (2016) The efficacy of intravitreal aflibercept in submacular hemorrhage secondary to wet age-related macular degeneration. Korean J Ophthalmol 30:369–376. https://doi.org/10.3341/kjo.2016.30.5.369

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tenbrock L, Wolf J, Boneva S et al (2022) Subretinal fibrosis in neovascular age-related macular degeneration: current concepts, therapeutic avenues, and future perspectives. Cell Tissue Res 387:361–375. https://doi.org/10.1007/s00441-021-03514-8

    Article  CAS  PubMed  Google Scholar 

  17. Daniel E, Pan W, Ying G-S et al (2018) Development and course of scars in the comparison of age-related macular degeneration treatments trials. Ophthalmology 125:1037–1046. https://doi.org/10.1016/j.ophtha.2018.01.004

    Article  PubMed  Google Scholar 

  18. Abdelfattah NS, Al-Sheikh M, Pitetta S et al (2017) Macular atrophy in neovascular age-related macular degeneration with monthly versus treat-and-extend ranibizumab: findings from the TREX-AMD trial. Ophthalmology 124:215–223. https://doi.org/10.1016/j.ophtha.2016.10.002

    Article  PubMed  Google Scholar 

  19. Xu L, Mrejen S, Jung JJ et al (2015) Geographic atrophy in patients receiving anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Retina 35:176–186. https://doi.org/10.1097/IAE.0000000000000374

    Article  CAS  PubMed  Google Scholar 

  20. Avery RL, Fekrat S, Hawkins BS, Bressler NM (1996) Natural history of subfoveal subretinal hemorrhage in age-related macular degeneration. Retina 16:183–189. https://doi.org/10.1097/00006982-199616030-00001

    Article  CAS  PubMed  Google Scholar 

  21. Glatt H, Machemer R (1982) Experimental subretinal hemorrhage in rabbits. Am J Ophthalmol 94:762–773. https://doi.org/10.1016/0002-9394(82)90301-4

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, 700-8558, Japan

    Mio Morizane Hosokawa, Chihiro Ouchi, Yusuke Shiode, Shuhei Kimura, Ryo Matoba, Tetsuro Morita & Yuki Morizane

Authors
  1. Mio Morizane Hosokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chihiro Ouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yusuke Shiode
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuhei Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryo Matoba
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tetsuro Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuki Morizane
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.M.H. designed the study; C.O. and M.M.H. analyzed and interpreted the data; Y.S., S.K., R.M., and T.M. collected the data; M.M.H. wrote the manuscript; Y.M. supervised the study. All the authors have reviewed the manuscript.

Corresponding author

Correspondence to Mio Morizane Hosokawa.

Ethics declarations

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Okayama University Hospital approved this study.

Consent to participate

The need for informed consent was waived because of the retrospective nature of the study.

Consent to publish

Not applicable.

Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hosokawa, M.M., Ouchi, C., Shiode, Y. et al. Influence of submacular hemorrhage at baseline on the long-term outcomes of aflibercept treatment for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol (2024). https://doi.org/10.1007/s00417-024-06453-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00417-024-06453-6

Keywords

Search

Navigation