Intravitreal Aflibercept With vs Without Pneumatic Displacement for Submacular Hemorrhage Associated With Polypoidal Choroidal Vasculopathy

<b>Purpose:</b> To compare the visual outcomes of intravitreal (IVT) aflibercept with pneumatic displacement vs without pneumatic displacement for submacular hemorrhage (SMH) associated with polypoidal choroidal vasculopathy (PCV). <b>Methods:</b> This retrospective study assessed patients with SMH associated with PCV who were treated with aflibercept and pneumatic displacement with gas (aflibercept+gas group) or with aflibercept alone (monotherapy group). Patients were followed for at least 12 months, with the best-corrected visual acuity (BCVA) at 12 months the primary outcome measure. <b>Results:</b> Forty-seven eyes of 47 patients were retrospectively analyzed from August 2013 to March 2023. The aflibercept+gas group comprised 25 eyes and the monotherapy group, 22 eyes. The 2 groups had comparable baseline characteristics. The mean logMAR best-corrected visual acuity (BCVA) before treatment was 0.78 ± 0.46 in the aflibercept+gas group and 0.83 ± 0.66 in the monotherapy group (<i>P</i> = .76). The mean BCVA (0.26 ± 0.42 vs 0.85 ± 0.57) and the mean change in (-0.52 ± 0.55 vs 0.02 ± 0.75) 12 months postoperatively was significantly better in the aflibercept+gas group than in the monotherapy group (<i>P</i> < .001 and <i>P</i> < .008, respectively). The BCVA improved by 3 or more lines in 60.0% of eyes in the aflibercept+gas group but in only 18.2% of eyes in the monotherapy group. Vitreous hemorrhage developed in 16.0% of eyes in the aflibercept+gas group and in 13.6% of eyes in the monotherapy group and retinal detachment in 4.0% and 0%, respectively (both <i>P</i> = 1.000). <b>Conclusions:</b> Better visual outcomes were achieved with IVT aflibercept and pneumatic displacement than with aflibercept alone for SMH associated with PCV.