Shortest Distance From Fovea to Subfoveal Hemorrhage Border Is Important in Patients With Neovascular Age-related Macular Degeneration

Saleema Kherani, Adrienne Scott, Adam Wenick, Ingrid E Zimmer Galler, Christopher J. Brady, Akrit Sodhi, Catherine Meyerle, Sharon Solomon, Rimsha Shaukat, Roomasa Channa, Olukemi Adeyemo, James Handa, Jiangxia Wang, Peter A Campochiaro

Research output: Contribution to journalArticle

Abstract

Purpose: 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. Design: Retrospective case series. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)86-95
Number of pages10
JournalAmerican Journal of Ophthalmology
Volume189
DOIs
StatePublished - May 1 2018

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Macular Degeneration
Hemorrhage
Visual Acuity
Vascular Endothelial Growth Factor A
Endothelial Growth Factors
Injections
Retina

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Shortest Distance From Fovea to Subfoveal Hemorrhage Border Is Important in Patients With Neovascular Age-related Macular Degeneration. / Kherani, Saleema; Scott, Adrienne; Wenick, Adam; Zimmer Galler, Ingrid E; Brady, Christopher J.; Sodhi, Akrit; Meyerle, Catherine; Solomon, Sharon; Shaukat, Rimsha; Channa, Roomasa; Adeyemo, Olukemi; Handa, James; Wang, Jiangxia; Campochiaro, Peter A.

In: American Journal of Ophthalmology, Vol. 189, 01.05.2018, p. 86-95.

Research output: Contribution to journalArticle

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title = "Shortest Distance From Fovea to Subfoveal Hemorrhage Border Is Important in Patients With Neovascular Age-related Macular Degeneration",
abstract = "Purpose: 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. Design: Retrospective case series. Methods: 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. Results: 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). Conclusions: 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.",
author = "Saleema Kherani and Adrienne Scott and Adam Wenick and {Zimmer Galler}, {Ingrid E} and Brady, {Christopher J.} and Akrit Sodhi and Catherine Meyerle and Sharon Solomon and Rimsha Shaukat and Roomasa Channa and Olukemi Adeyemo and James Handa and Jiangxia Wang and Campochiaro, {Peter A}",
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T1 - Shortest Distance From Fovea to Subfoveal Hemorrhage Border Is Important in Patients With Neovascular Age-related Macular Degeneration

AU - Kherani, Saleema

AU - Scott, Adrienne

AU - Wenick, Adam

AU - Zimmer Galler, Ingrid E

AU - Brady, Christopher J.

AU - Sodhi, Akrit

AU - Meyerle, Catherine

AU - Solomon, Sharon

AU - Shaukat, Rimsha

AU - Channa, Roomasa

AU - Adeyemo, Olukemi

AU - Handa, James

AU - Wang, Jiangxia

AU - Campochiaro, Peter A

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Purpose: 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. Design: Retrospective case series. Methods: 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. Results: 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). Conclusions: 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.

AB - Purpose: 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. Design: Retrospective case series. Methods: 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. Results: 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). Conclusions: 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.

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