I offer the following observations regarding the recent study by Cho and associates. Intravitreal bevacizumab for exudative complications of retinal artery macroaneurysm was first reported in 2009. Since then, there have been several reports indicating benefit from intravitreal bavacizumab for both hemorrhagic and exudative complications of retinal artery macroaneurysm. However, there seems to be little benefit or rationale for such therapy for subfoveal hemorrhage from ruptured retinal artery macroaneurysm. Hemorrhage from retinal artery macroaneurysm, unlike exudation, which is a continuous process that can be demonstrated by leakage on fluorescein angiography, is generally a one-time event that commonly leads to fibrosis and occlusion of retinal artery macroaneurysm. Visual loss usually results from atrophy of retinal pigment epithelium owing to well-established toxicity of subfoveal blood. Both patients in the present study (Patients 10 and 12) who presented with subfoveal bleed suffered further loss of vision ≥0.3 logMAR because of retinal pigment epithelial atrophy. Bevacizumab-induced clearing of blood in 4 weeks, as opposed to 8 weeks natural history as reported by the authors, might still be too slow to prevent irreversible damage to photoreceptors. Thus, early evacuation of subfoveal blood offers the best chance for improvement in vision in such eyes. Since the initial report of tissue plasminogen activator–assisted evacuation of submacular blood from ruptured retinal artery macroaneurysm, excellent visual outcomes have been reported with this approach by others. Each of the 9 eyes achieved significant improvement in vision with tissue plasminogen-assisted removal of blood without any laser treatment to the retinal artery macroaneurysm.