Intravitreal Bevacizumab, Plasminogen, and Pneumatic Retinopexy for Subfoveal Hemorrhage in Age-Related Macular Degeneration.

Purpose: To evaluate the therapeutic effect of intravitreal bevacizumab combined with intravitreal plasminogen and pneumatic retinopexy as treatment of subfoveal hemorrhages due to exudative age-related macular degeneration. Design: Clinical interventional case series study. Methods: Ten patients (10 eyes) with exudative age-related macular degeneration, presented with a subfoveal hemorrhage larger than 1 disc size and smaller than 5 disc sizes. They received an intravitreal injection of 50 Kg of plasminogen and 0.3 mL of 100% sulfur hexafluoride gas combined with intravitreal 1.5 mg of bevacizumab, followed by 2 additional intravitreal injections of 1.5 mg of bevacizumab in an interval of 6 weeks. Results: Mean visual acuity improved slightly, although not statistically significant (P = 0.24), from 1.56 T 0.47 to 1.48 T 0.60 logMAR at 1 month after the procedure and to 1.35 T 0.54 logMAR at 3 months after baseline. Subfoveal hemorrhage recurred in none of the patients during the follow-up. In all patients, the subfoveal hemorrhage had at least partially been moved to the infrafoveal region. Pronounced degenerative subfoveal changes were the main reason for a lack of a marked increase in visual acuity after the procedure. Conclusions: For some patients with exudative age-related macular degeneration and a subfoveal hemorrhage larger than 1 disc size and smaller than 5 disc sizes, the combined intravitreal injection of bevacizumab, plasminogen, and gas followed by 2 additional intravitreal bevacizumab injections can lead to a stabilization or slight improvement in visual acuity, unless subfoveal degenerative changes are not too marked to prevent a gain in vision.