Prognostic Factors and Long-term Surgical Outcomes for Exudative Age-related Macular Degeneration with Breakthrough Vitreous Hemorrhage

Purpose: We sought to evaluate the long-term outcomes for patients with exudative age-related macular degeneration (AMD)undergoing vitrectomy for breakthrough vitreous hemorrhage and to investigate possible prognostic factors. Methods: Consecutive patients treated at two high-volume referral-based tertiary hospitals between July 2006 and December2019 were retrospectively reviewed. Surgery was performed using the standard three-port vitrectomy. The primary outcomewas the change in best-corrected visual acuity (BCVA) over long-term follow-up, while secondary outcomes includedthe assessment of possible prognostic factors. Results: Among 50 eyes from 50 patients included in this study, 23 (46%) were diagnosed with polypoidal choroidal vasculopathy(PCV) and 27 (54%) were diagnosed with neovascular AMD. Preoperative vision at the time of vitreous hemorrhageonset was 20 / 3,027 (logarithm of the minimum angle of resolution [logMAR], 2.18 ± 0.34). At 12 months after surgery, themean BCVA improved to 20 / 873 (logMAR, 1.64 ± 0.76; p < 0.001). At 24 months, the BCVA was 20 / 853 (logMAR, 1.63 ±0.75; p < 0.001). Univariate analysis revealed that older age (odds ratio [OR], 0.879; p = 0.007] and the presence of submacularhemorrhage (OR, 0.081; p = 0.022) were factors associated with a poor 2-year visual outcome. Multivariable regressionshowed that older age (OR, 0.876; p = 0.026) and neovascular AMD (as compared with PCV) (OR, 0.137; p = 0.014) weresignificant negative factors influencing the 2-year visual outcome. The mean injection interval prior to vitrectomy was 4.53months, which extended to 27.64 months after vitrectomy (p = 0.028). Conclusions: Younger age, the absence of submacular hemorrhage, and PCV type were associated with a favorable 2-yearvisual outcome after vitrectomy for vitreous hemorrhage in patients with exudative AMD. Overall, vitrectomy resulted in improvedvisual acuity and patients showed a decreased need for anti-vascular endothelial growth factor therapy thereafter