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Graefe's Archive for Clinical and Experimental Ophthalmology

16-04-2024 | Macular Degeneration | Retinal Disorders

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

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

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology

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.

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.2014.08.020CrossRefPubMed

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.2021.09.033CrossRefPubMed

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.0271447CrossRefPubMedPubMedCentral

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/s00417-019-04474-0CrossRefPubMed

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.2013.11.004CrossRefPubMed

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.2012.09.006CrossRefPubMed

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/NEJMoa054481CrossRefPubMed

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.0000000000001872CrossRefPubMed

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.0261320CrossRefPubMedPubMedCentral

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/s10384-023-00981-0CrossRefPubMed

11.

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

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/s10384-019-00679-2CrossRefPubMed

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/s10384-016-0492-7CrossRefPubMed

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.2016.30.5.369CrossRefPubMedPubMedCentral

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/s00441-021-03514-8CrossRefPubMed

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.2018.01.004CrossRefPubMed

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.2016.10.002CrossRefPubMed

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.0000000000000374CrossRefPubMed

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/10.1097/00006982-199616030-00001CrossRefPubMed

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)90301-4CrossRefPubMed

Title: 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
Authors: Mio Morizane Hosokawa
Chihiro Ouchi
Yusuke Shiode
Shuhei Kimura
Ryo Matoba
Tetsuro Morita
Yuki Morizane
Publication date: 16-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Macular Degeneration
Aflibercept
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-024-06453-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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