The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Ophthalmol. 2018 May;189:86-95. doi: 10.1016/j.ajo.2018.02.015. Epub 2018 Feb 28.
To identify factors influencing visual outcome in patients with neovascular age-related macular degeneration (NVAMD) and subfoveal hemorrhage (SFH) treated with anti-vascular endothelial growth factor (VEGF) agents.
Retrospective case series.
Anti-VEGF-treated eyes with SFH > 1 disc area (DA) were identified (n = 16) and changes in visual acuity (VA) and central subfield thickness (CST) from baseline to last follow-up, along with SFH area, thickness, minimum distance from fovea to SFH border, and time to resolution, were determined.
At baseline, mean (± standard error of the mean) size and thickness of SFH were 14.9 ± 2.8 DA and 386.6 ± 46.9 μm, and mean Snellen VA and CST were 20/250 and 591.7 ± 57.0 μm. Median follow-up was 47.6 months. While more than 50% of patients had VA ≤ 20/200 at baseline and all time points through week 48, the percentage of patients with VA ≥ 20/50 increased to 30%-40% at months 6 and 12 and remained stable through month 48. Spearman rank correlation demonstrated 2 independent variables that correlated with good visual outcome, smaller area of SFH at baseline (r = -0.630; P = .009), and high frequency of anti-VEGF injections (r = 0.646; P = .007). In exceptional patients with good visual outcome despite large baseline SFH, shortest distance between the fovea and hemorrhage border significantly correlated with baseline VA (r = -0.503, P = .047) and final VA (r = -0.575, P = .02).
Patients with NVAMD and thick SFH, but short distance between fovea and uninvolved retina, can have good visual outcomes when given frequent anti-VEGF injections.
确定接受抗血管内皮生长因子（VEGF）治疗的新生血管性年龄相关性黄斑变性（NVAMD）伴中心凹下出血（SFH）患者的视觉预后的影响因素。
回顾性病例系列。
确定 SFH > 1 个视盘面积（DA）的接受抗 VEGF 治疗的眼（n = 16），并确定从基线到最后一次随访时视力（VA）和中央视网膜神经纤维层厚度（CST）的变化，SFH 面积、厚度、SFH 边界与黄斑中心凹的最小距离以及出血吸收时间。
基线时，SFH 的平均（±均数标准误）大小和厚度分别为 14.9 ± 2.8 DA 和 386.6 ± 46.9 μm，平均 Snellen VA 和 CST 分别为 20/250 和 591.7 ± 57.0 μm。中位随访时间为 47.6 个月。尽管基线时超过 50%的患者 VA ≤ 20/200，并且在第 48 周的所有时间点均如此，但在第 6 和 12 个月时，VA ≥ 20/50 的患者比例增加到 30%至 40%，并在第 48 个月时保持稳定。Spearman 秩相关分析显示，2 个独立变量与良好的视觉预后相关，SFH 基线面积较小（r = -0.630；P =.009）和高抗 VEGF 注射频率（r = 0.646；P =.007）。在基线 SFH 较大但视力预后良好的特殊患者中，黄斑中心凹与出血边界之间的最短距离与基线 VA（r = -0.503，P =.047）和最终 VA（r = -0.575，P =.02）显著相关。
对于接受频繁抗 VEGF 治疗的 NVAMD 患者和厚 SFH 患者，只要黄斑中心凹与未受累视网膜之间的距离较短，就可以获得良好的视力预后。
