Occurrence of macular hematoma after ranibizumab treatment for age-related macular degeneration.

Abstract

PURPOSE:

To report the occurrence and study the characteristics of macular hematoma after ranibizumab (anti-VEGF) intravitreal injection for subfoveal choroidal neovascularization in age-related macular degeneration (AMD).

METHODS:

The charts of 6000 patients treated with ranibizumab (0.5 mg) for exudative AMD were reviewed. Inclusion criteria were a minimum follow-up of 1 year after the first injection and the occurrence of a large macular hematoma involving the fovea in patients with macular lesions considered stabilized or still active. All patients had a complete ophthalmologic assessment including Early Treatment of Diabetic Retinopathy Study visual acuity (VA) measurement, fundus photography, fundus fluorescein angiography, scanning laser ophthalmoscopy-infracyanine green angiography, and spectral-domain optical coherence tomography.

RESULTS:

Of the 6000 eyes, 24 (0.4%) developed macular hematoma during follow-up. There were 8 men (33.3%) and 16 women (66.7%). The mean age at the time of initial presentation was 76.7 ± 3.8 years (range 61-81 years). The mean time to occurrence of macular hematoma after the last injection was 4.8 months. Spectral-domain optical coherence tomography showed the presence of a retinal pigment epithelium (RPE) tear in 19 eyes (79.1%). Vitreomacular traction (VMT) was only present in 4 eyes (17%). Final VA after macular hematoma resorption was <20/50 in 17 cases (70.9%) and ≥20/50 in 7 cases (29.1%).

CONCLUSIONS:

Macular hematoma may follow intravitreal anti-VEGF injection for exudative AMD with large occult neovascularization, especially if a large RPE tear is found. The occurrence does not seem to be linked to anticoagulation treatment or the presence of VMT.

• Authors: Georges Azar, Martine Mauget-Faÿsse, Jasmine Nyouma, Salomon Yves Cohen, Florence Coscas, Catherine Français-Maury, Eric Souied, Gisèle Soubrane
• Journal: European journal of ophthalmology (Eur J Ophthalmol) 2015 Mar-Apr Vol. 25 Issue 2 Pg. 163-7 ISSN: 1724-6016 [Electronic] United States
• PMID: 25684081 (Publication Type: Journal Article)

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Coloring Agents
• Infracyanine green
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• Indocyanine Green
• Ranibizumab

Topics

• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Coloring Agents
• Female
• Fluorescein Angiography
• Hematoma (chemically induced, diagnosis)
• Humans
• Indocyanine Green (analogs & derivatives)
• Intravitreal Injections
• Male
• Middle Aged
• Ophthalmoscopy
• Ranibizumab
• Retinal Hemorrhage (chemically induced, diagnosis)
• Tomography, Optical Coherence (methods)
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity
• Wet Macular Degeneration (drug therapy)