Acute Submacular Hemorrhage Resulting from Neovascular Age-Related Macular Degeneration in a Monocular Patient

Purpose: To present the management and outcomes of a case of an acute submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD). Methods: A single case was retrospectively evaluated. Results: A 79-year-old man with a history of submacular hemorrhage from nAMD and persistent disease activity in the left eye presented with an acute submacular hemorrhage in his better-seeing right eye, which was previously closely monitored for an extrafoveal serous pigment epithelial detachment without exudation. The patient received intravitreal antivascular endothelial growth factor (anti-VEGF) and subsequently had pars plana vitrectomy with subretinal tissue plasminogen activator and gas tamponade. After 5 days of face-down positioning, the hemorrhage was successfully displaced from the fovea. Recurrent disease activity 2 weeks postoperatively prompted intensive biweekly anti-VEGF therapy. By postoperative month 5, the patient's visual acuity improved from 20/400 to 20/70 OD. Conclusions: This case highlights the importance of close monitoring of patients with nAMD who exhibit aggressive disease as well as the efficacy of prompt surgical intervention and increased anti-VEGF frequency for large submacular hemorrhages.