Submacular Hemorrhage Following Aflibercept Intravitreal Injection: A Report of Two Cases

Area of Science:

• Ophthalmology
• Retinal diseases
• Medical treatments

Background:

• Anti-vascular endothelial growth factor (anti-VEGF) injections are the gold standard for treating exudative age-related macular degeneration (AMD).
• Bevacizumab and ranibizumab, common anti-VEGF agents, have known risks of causing submacular hemorrhage (SMH).
• Aflibercept is also an anti-VEGF agent used for retinal conditions, with prior reports of SMH primarily in polypoidal choroidal vasculopathy, not exudative AMD.

Observation:

• This case series details two female patients diagnosed with exudative AMD.
• The first patient, 84, experienced SMH four days post-aflibercept injection in her right eye.
• The second patient, 77, developed SMH one month after an aflibercept injection for her left eye.

Findings:

• Aflibercept injections, while effective for exudative AMD, may rarely lead to submacular hemorrhage.
• These cases suggest that SMH is a potential complication of aflibercept even in the context of exudative AMD, not solely polypoidal choroidal vasculopathy.
• The incidence and specific risk factors for aflibercept-associated SMH in exudative AMD remain to be determined.

Implications:

• Ophthalmologists should be aware of the potential for SMH following aflibercept treatment in exudative AMD patients.
• Further research is warranted to establish the true incidence and identify risk factors for this rare complication.
• This underscores the importance of continued surveillance and reporting of adverse events in anti-VEGF therapy.