Submacular haemorrhages after intravitreal bevacizumab for large occult choroidal neovascularisation in age-related macular degeneration

Abstract

Objective: To report the occurrence of submacular haemorrhages following intravitreal bevacizumab for occult choroidal neovascularisation (CNV) in age-related macular degeneration (AMD).

Methods: Retrospective chart review of 53 patients with occult CNV who had received intravitreal bevacizumab 1.25 mg. Analysis was done in three groups based on mean CNV lesion size: <10 mm² (n = 17), ≥10 to <15 mm² (n = 17) and ≥15 mm² (n = 18). ETDRS derived acuity, incidence of fresh macular haemorrhages and haemorrhage size (pre-existing or fresh) were documented and analysed.

Results: The median injection number was 1.0 (range: 1 to 3) with a minimum follow-up of 6 months (range: 4 to 12 months). The mean presenting size of occult lesions was 13.4 mm² (range: 3.0 to 30.3 mm²). Submacular fresh haemorrhages were seen in the absence of pre-existing haemorrhage in four out of 10 patients in the ≥15 mm² CNV size group (40%) but none in the remaining groups with CNV sizes <15 mm² (OR = 20.1, p = 0.01, 95% CI = 0.99 to 409.3). These haemorrhages developed at a median of 14 days.

Conclusions: Submacular haemorrhages seem to be a significant adverse event following intravitreal bevacizumab in large occult choroidal neovascularisation and may affect visual outcomes. Prospective studies are required to establish the optimal dose of bevacizumab for larger lesion sizes or to identify the most appropriate anti-VEGF agent in large occult CNV with fibrovascular and serous PED lesions.