Natural history of macular subretinal hemorrhage in age-related macular degeneration.
OBJECTIVE
To define the natural course of extensive submacular hemorrhage in age-related macular degeneration (AMD).


METHODS
The clinical charts of 54 patients (60 eyes) older than 55 years with subretinal hemorrhage larger than 1 disk diameter and extending beneath the fovea were retrospectively reviewed. The age of the patient, the use of antihypertensive or anticoagulant medication, visual acuity, biomicroscopic and fluorescein and indocyanine green (in 33 cases) angiographic data were recorded at presentation and during follow-up.


RESULTS
At the initial examination, average visual acuity was 20/240 (range from 20/70 to light perception). During follow-up (mean 24 months) visual acuity worsened in 80% of the eyes with a mean final visual acuity of 20/1, 250 (range from 20/100 to light perception). The initial size and thickness of hemorrhage were correlated with initial and final visual acuity. Recurrence of hemorrhage resulted in an important impact on final visual acuity. Anatomic outcome showed fibrous tissue proliferation in 23 eyes (38.3%), atrophic scar in 15 eyes (25%) and occurrence of a retinal pigment epithelium tear in 13 eyes (21.6%).


CONCLUSIONS
The visual outcome in eyes with submacular hemorrhages due to AMD is very poor. Size and thickness of the hemorrhage influenced negatively the natural prognosis. A surgical approach can be considered although it has not yet a widespread use.
Scupola
A
A
Department of Ophthalmology, University of L'Aquila, Italy.
Coscas
G
G
Soubrane
G
G
Balestrazzi
E
E
D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D017075:Laser Coagulation; D008266:Macula Lutea / Q000473:pathology* / Q000601:surgery; D008268:Macular Degeneration / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012008:Recurrence; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D014792:Visual Acuity
D004396:Coloring Agents; D007208:Indocyanine Green