Managing Massive Subretinal Hemorrhage Without Surgery

Two patients with massive subretinal hemorrhage demonstrated sustained long-term stability following intravitreal anti-VEGF monotherapy.

By
Michael Y. Zhao, MD
Harry W. Flynn Jr., MD
July 1, 2026
11 min

Retinal Physician

Objective:

To report the long-term outcomes of two patients with massive subretinal hemorrhage (mSRH) treated with intravitreal anti-VEGF monotherapy, highlighting the challenges in managing this condition.

Approach:

Patient 1: A 71-year-old female with wet AMD presented with blurred vision and mSRH. She received monthly ranibizumab injections for 4 months, followed by 10 years of follow-up showing stable macular changes.
Patient 2: A 60-year-old female with PEHCR presented with blurred vision and mSRH. She received monthly bevacizumab injections for 5 months, followed by 20 years of follow-up showing stable visual acuity and no recurrent hemorrhage.

Key Findings:

Both patients demonstrated sustained long-term stability following anti-VEGF monotherapy, with Patient 1's initial BCVA of 20/40 in the right eye and 5/200 in the left eye, and Patient 2's initial BCVA of 20/200 in the right eye and 20/20 in the left eye.
Patient 1's best-corrected visual acuity (BCVA) was 20/200 at last follow-up, with localized RPE atrophy.
Patient 2's BCVA improved to 20/25 at last follow-up, with stable subretinal pigment and persistent macular drusen.

Interpretation:

Intravitreal anti-VEGF therapy may provide a management option for mSRH.

Limitations:

The study is based on only two case reports, limiting generalizability due to the small sample size.
Long-term follow-up data may not be representative of broader patient populations.