Occurrence of macular hematoma after ranibizumab treatment for age-related macular degeneration

Purpose: To report the occurrence and study the characteristics of macular hematoma after ranibizumab (antiVEGF) intravitreal injection for subfoveal choroidal neovascularization in age-related macular degeneration (AMD). Methods: The charts of 6000 patients treated with ranibizumab (0.5 mg) for exudative AMD were reviewed. Inclusion criteria were a minimum follow-up of 1 year after the first injection and the occurrence of a large macular hematoma involving the fovea in patients with macular lesions considered stabilized or still active. All patients had a complete ophthalmologic assessment including Early Treatment of Diabetic Retinopathy Study visual acuity (VA) measurement, fundus photography, fundus fluorescein angiography, scanning laser ophthalmoscopy-infracyanine green angiography, and spectral-domain optical coherence tomography. Results: Of the 6000 eyes, 24 (0.4%) developed macular hematoma during follow-up. There were 8 men (33.3%) and 16 women (66.7%). The mean age at the time of initial presentation was 76.7 ± 3.8 years (range 61-81 years). The mean time to occurrence of macular hematoma after the last injection was 4.8 months. Spectral-domain optical coherence tomography showed the presence of a retinal pigment epithelium (RPE) tear in 19 eyes (79.1%). Vitreomacular traction (VMT) was only present in 4 eyes (17%). Final VA after macular hematoma resorption was <20/50 in 17 cases (70.9%) and ≥20/50 in 7 cases (29.1%). Conclusions: Macular hematoma may follow intravitreal anti-VEGF injection for exudative AMD with large occult neovascularization, especially if a large RPE tear is found. The occurrence does not seem to be linked to anticoagulation treatment or the presence of VMT.