Prognostic Factors in Patients With Submacular Haemorrhage Complicating Age‐Related Macular Degeneration: A Post Hoc Analysis of the STAR Study

BACKGROUND: To investigate prognostic factors of recent submacular haemorrhage (SMH) complicating neovascular age-related macular degeneration (nAMD) treated with surgery or pneumatic displacement combined with intravitreal injection of anti-vascular endothelial growth factor. METHODS: Post hoc analysis of the STAR randomised controlled trial data evaluating the influence of baseline clinical and imaging characteristics on visual outcomes over 6 months using multivariate generalised additive mixed models. RESULTS: Patients with worse baseline visual acuity (VA) had faster (estimated degree of freedom [EDF] = 2.87, p < 0.001) and greater predicted visual gain (difference = +21.03 [14.64; 27.42] letters for eyes with 10 vs. 40 letters at baseline, p < 0.001) and lower predicted VA at 6 months (difference = -8.82 [-15.14; -2.52] letters for eyes with 10 vs. 40 letters at baseline, p < 0.001), whereas patients with better baseline VA showed more stable trajectories of predicted visual gain and higher predicted VA at 6 months. Thinner SMH (≤ 1000 μm) was significantly associated with faster (EDF = 2.93 for ≤ 1000 μm vs. 2.66 for > 1000 μm) and greater predicted visual improvement (difference = +13.5 [3.66; 23.39] letters between ≤ 1000 and > 1000 μm, p < 0.001) and higher predicted final VA (difference = +13.00 [3.11; 22.80] letters between ≤ 1000 and > 1000 μm, p < 0.001). Interactions between the treatment group and both VA and SMH thickness were non-significant. CONCLUSION: Better VA and lower SMH thickness at baseline were significantly associated with better visual outcomes over 6 months, independently of treatment arm in SMH complicating nAMD. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02557451.