ANALYSIS OF CLINICAL CASES АНТИ-VEGF TREATMENT OF MASSIVE SUBRETINAL HEMORRHAGES COMPLICATING WET AGE-RELATED MACULAR DEGENERATION

• Main Authors: E. V. Kozina, A. G. Zabolotniy, A. V. Malafeev
• Format: Article
• Language: Russian
• Published: Publishing house "Ophthalmology" 2017-01-01
• Series: Офтальмохирургия
• Subjects: wet age-related macular degeneration; submacular hemorrhage; anti-vegf therapy; pigment epithelial tear
• Online Access: https://www.ophthalmosurgery.ru/jour/article/view/279
• ISSN: 0235-4160; 2312-4970

Purpose. Analysis of clinical cases of anti-VEGF therapy (ranibizumab) in the treatment of wet age-related macular degeneration (AMD) complicated by massive subretinal hemorrhages of various sizes.Material and methods. A retrospective analysis of the results of treatment was performed in 18 patients with wet AMD complicated by massive subretinal hemorrhages, who received as a treatment three monthly intravitreal ranibizumab injections. The first group (10 eyes) included patients with hemorrhages ranging from 1.5 to 3 disc diameters (DD), the second group (8 eyes) – patients with subretinal hemorrhage area of up to 1.5 DD. The age of patients varied from 65 to 83 years. The study was conducted using visometry, ophthalmoscopy of the damaged eye and of the fellow eye, as well as a monthly photo-registration of fundus and the OCT of macular area. The examinations were carried out before the treatment and 1 month after each ranibizumab IVI conducted by the standard technology in a sterile operating room.Results. After 3 monthly ranibizumab IVI in 8 patients of the second group the ophthalmoscopy showed a complete resorption of subretinal blood already after the 2nd ranibizumab IVI. According to the OCT a normalization of anatomy in the macular area was noted. Visometry results and patients subjectively reported a gradual improvement in visual acuity in the course of treatment, in some cases up to a full recovery by the end of the third month of therapy. A pigment epithelial tear, passing through the foveal zone, was detected in the treatment process associated with resorption of submacular clumps in 9 of 10 patients of the first group with areas of subretinal hemorrhages more than 1.5 DD. A complete attachment and a recovery profile of the foveal zone were not observed in any patients even after the full course of anti-VEGF therapy. A total hemophthalmus developed in one eye in the postinjection period that required the vitrectomy surgery. The visual acuity in patients of the first group decreased from 0.3 to0.15 in the anti-VEGF therapy in the majority of cases. At the same time all patients reported a subjective improvement in the quality of vision – a reduction of the size and intensity of the central scotoma darkening due to a resorption of subretinal blood in the central area of the retina.Conclusion. The therapy with intravitreal injections of ranibizumab is indicated and effective in patients with hemorrhages more than 1.5 DD. anti-VEGF therapy leads to an improvement in the life quality of patients and facilitates their adaptation to a visual impairment, due to a total or partial resorption of subretinal blood and a reduction in the area and intensity of the central scotoma.