Comparative analysis of long-term outcomes of submacular hemorrhage in AMD: a real-life study.

Introduction Submacular hemorrhage (SMH) is a severe complication of neovascular age-related macular degeneration (nAMD), often causing profound vision loss. The aim of this study was to assess the long-term outcomes of SMH patients managed with anti-VEGF monotherapy (MT) versus surgical displacement (SD) and to identify prognostic factors for visual acuity. Methods This multicenter retrospective study included patients with SMH secondary to nAMD treated in three hospitals in Lyon between 2018 and 2023. Patients were treated with MT or underwent pneumatic displacement (PD) or SD. The best-corrected visual acuity (BCVA) and clinical parameters were assessed at baseline (time of SMH onset), months 1, 3, 9 and 12. Results Sixty-six eyes were included: 33 received MT, 6 underwent PD, and 27 underwent SD. The baseline VA was strongly reduced (mean BCVA: 0.14). The VA improved to 0.21 at M1, 0.29 at M3, and 0.33 at M6 but was stabilized at 0.28 at M12. At M12, VA did not significantly differ between MT and SD groups (0.27 vs. 0.32, p = 0.624). However, multivariate analysis revealed a significantly greater VA gain in the SD group (p = 0.025), despite more severe baseline characteristics. SMH thickness was significantly associated with a poorer VA (p=0.02). Conclusion Surgical displacement may offer greater visual improvement in cases of large and thick SMH. Maximum SMH thickness appears to be a key prognostic factor. Treatment decisions should consider initial hemorrhage severity.