title: Focal inner retinal hemorrhages in patients with drusen: an early sign of occult choroidal neovascularization and chorioretinal anastomosis.
abstract: OBJECTIVE
  To present evidence that superficial retinal hemorrhage in the macula of patients with age-related macular degeneration (ARMD) may be an early sign of occult chorioretinal anastomosis (OCRA) and type 1 occult choroidal neovascularization (OCNV).
  
  
  METHODS
  Retrospective follow-up study of 16 patients presenting with a small focal area of superficial retinal hemorrhages and drusen in the juxtafoveolar area in 24 eyes.
  
  
  RESULTS
  OCRA and OCNV occurred in an older subset of patients with ARMD (mean age, 75 years). Of 22 eyes with the early stages of chorioretinal anastomosis (CRA), 18 had evidence of a piggyback neovascular complex, with the smaller subsensory retinal type 2 complex lying anterior to the larger subretinal pigment epithelial type 1 complex. At initial presentation, three patients had OCRA and OCNV bilaterally, and three patients had large disciform cicatricial lesions with overt CRA in the fellow eye. Nine patients had one or more laser photocoagulation treatments for early stages of CRA. Only one patient maintained visual acuity of better than 20/200 for >1 year. At the last follow-up, 24 of 26 eyes with CRA had visual acuity of 20/200 or less.
  
  
  CONCLUSIONS
  Superficial retinal hemorrhage in the paracentral area of patients with drusen is the earliest sign of OCRA and OCNV. Fluorescein angiography and indocyanine green angiography are important in detecting the dual nature of the subretinal neovascular network. Photocoagulation and photodynamic treatment is usually unsuccessful in preserving central vision.
authors.affiliation: Department of Ophthalmology, Vanderbilt University Medical School, Nashville, Tennessee 37232-8808, USA.
authors.forename: J Donald M
authors.initials: JD
authors.lastname: Gass
authors.forename: Anita
authors.initials: A
authors.lastname: Agarwal
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Lavina
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Tawansy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002829:Choroid / Q000098:blood supply*; D020256:Choroidal Neovascularization / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D015593:Retinal Drusen / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D012166:Retinal Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D012171:Retinal Vessels / Q000002:abnormalities*; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green