Abstract

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

METHODS: Retrospective chart review of 53 patients with occult CNV who had received intravitreal bevacizumab 1.25mg. Analysis was done in 3 groups based on mean CNV lesion size i.e., <10 mm2 (n=17), >10 to <15 mm2 (n=17) and >15 mm2 (n=18). ETDRS derived acuity, incidence of fresh macular haemorrhages and hemorrhage size (pre-existing or fresh) were documented and analysed.

RESULTS: Median injection number was 1.0 (range: 1 to 3) with a minimum follow-up of 6 months (range: 4 to 12 months). Mean presenting size of occult lesions was 13.4 mm2 (range: 3.0 to 30.3 mm2). Sub-macular fresh haemorrhages were seen in the absence of pre-existing hemorrhage in 4 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: Sub-macular haemorrhages seem to be a significant adverse event following intravitreal bevacizumab in large occult choroidal neovascularization 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.