Long-Term Outcome of Intravitreal Expansile Gas and Bevacizumab Injection for Macular Neovascularization-Induced...

To analyze the results of the long-term outcome of pneumatic displacement (PD) with intravitreal bevacizumab (IVB) for subfoveal hemorrhage (SFH) secondary to polypoidal choroidal vasculopathy (PCV)/macular neovascularization secondary to neovascular age-related macular degeneration (n-AMD).

This is a retrospective and interventional study executed in the population of southern part of India who attended a tertiary care ophthalmic hospital over a decade. Patients who presented with a complaint of diminution of vision following SFH secondary to PCV or n-AMD who were treated with PD using sulphur hexafluoride (SF₆) along with IVB were included in the study. The patients were followed up for at least 24 months posttreatment. Finally, a dataset of 54 patients was chosen who fulfilled all the criteria and a thorough analysis on their long-term outcome was done.

The mean age at baseline was 57.55 ± 13.02 years. Average treatment delay was measured 9.43 ± 5.22 days. Best-corrected visual acuity (BCVA) on presentation was 1.07 ± 0.46 in logMAR. The average size of the SFH was measured 4.46 ± 1.17-disc diameter area. The average long-term follow-up was measured 29.33 ± 4.53 months. Final BCVA improved to 0.74 ± 0.62 in logMAR (P < 0.001). Overall improvement in BCVA was significantly better, although only a minority of patients (n = 24, 44.44%) improved BCVA ≥ 0.3 in logMAR. Subgroup analysis reveals smaller SFH (≤2 disc diameter) and presentation earlier than 1 week shows comparatively better visual outcome.

The study shows encouraging results on the long-term follow-up with respect to anatomical and visual acuity outcome. This serves as the second largest dataset on PD with IVB for SFH secondary to PCV/n-AMD in ophthalmic literature.