Intravitreal expansile gas and bevacizumab injection for submacular hemorrhage due to neovascular age-related macular degeneration

To evaluate the results of intravitreal expansile gas injection, with or
without recombinant tissue plasminogen activator (rtPA), followed by intravitreal
bevacizumab injection for treatment of submacular hemorrhage (SMH) secondary
to neovascular age-related macular degeneration (AMD).
Methods: In this interventional case series, 5 eyes of 5 patients with SMH secondary
to choroidal neovascularization (CNV) due to neovascular AMD were treated with 0.3
cc intravitreal SF6 (and 50 μg of rtPA in two eyes), followed by face-down positioning;
24 hours later, 1.25 mg of bevacizumab was injected intravitreally. Main outcome
measures included displacement of SMH and best corrected visual acuity (BCVA).
Results: Mean patient age was 75.6±9.2 (range, 60-83) years, mean duration of symptoms
was 6.4±3.2 (range, 3-10) days, and mean number of bevacizumab injections was
1.8 (range, 1-3). Mean preoperative BCVA was 1.28±0.27 logMAR which improved
significantly to 0.57±0.33 logMAR at 12 months (P=0.042). SMH displacement occurred
in all eyes, and visual acuity improved and remained stable during the follow-up
period of 12 months.
Conclusion: Intravitreal expansile gas injection, with or without rtPA, followed
by intravitreal bevacizumab injection, seems to be an effective modality for SMH
displacement and treatment of the underlying CNV in neovascular AMD.