Here we go again, I have a 62 year old female patient who had cataract surgery almost 2 years ago, done by a colleague. So happened that the vision did not improve as it was still counting fingers. When she was referred to me, she presented with a dense vitreous hemorrhage. Scheduled her for a vitrectomy. Intra-operatively, I saw a ruptured retinal macroaneurysm. (One of the common causes of vitreous hemorrhage in the elderly). Vision improved to 20/70. After a few months, she began complaining of distorted vision on the operated eye, with the vision going down to 20/400. Examination reveals the presence of a neovascular AMD developing on the same eye (How unlucky can she get). Advised intra-vitreal Avastin (bevacizumab), vision improved to 20/100 with diminution of the subretinal fluid. On follow-up, the membrane became more pronounced (I think it's a type 2 membrane, well delineated and no PEDs) and Avastin doesn't seem to take effect anymore (after 3 doses). Now, I'm contemplating on submacular surgery. Guarded prognosis for AMD I might say (SST says it is no different from natural course or PDT, though no direct comparison to anti-VEGF treatment)