title: Surgical outcomes after massive subretinal hemorrhage secondary to age-related macular degeneration.
abstract: OBJECTIVE
  Massive subretinal hemorrhage (SRH), defined as a thick submacular bleed that extends past the equator in at least two quadrants, is a rare sequela of age-related macular degeneration. This report describes outcomes after surgical intervention for massive SRH.
  
  
  METHODS
  The study design is a retrospective interventional case series. Records of consecutive patients who underwent surgical intervention for massive SRH were reviewed. Outcomes included change from baseline in postoperative acuity at Months 1, 3, 6, 9, and 12 and postoperative complications.
  
  
  RESULTS
  Fifteen consecutive eyes of 13 patients who underwent surgery for massive SRH were included. Procedures performed on initial surgery included subretinal instillation of 25 μg/0.1 mL tissue plasminogen activator (15 of 15), gas tamponade (12 of 15), oil tamponade (3 of 15), 180° or greater retinotomy (4 of 15), and/or cataract extraction (2 of 15). Patients were followed for a median of 20 months (range, 3-66 months). The median visual acuity at baseline and postoperative Month 1 was hand motions but improved to counting fingers at postoperative Months 3 (P = 0.04), 6 (P = 0.04), 9 (P = 0.04), and 12 (P = 0.10). Of the 15 eyes, 9 required at least 1 additional procedure for an indication of hyphema and/or vitreous hemorrhage (n = 6), retinal detachment (n = 2), glaucoma (n = 1), cataract (n = 1), and aphakia (n = 1). At the time of the onset of SRH, 5 of 13 patients were anticoagulated with warfarin (4 patients) or clopidogrel (1 patient), and 1 was diagnosed with a coagulopathy, factor XI deficiency.
  
  
  CONCLUSIONS
  Massive SRH related to age-related macular degeneration has a grave prognosis. Risk factors may include anticoagulation and coagulopathy. Limitations of the study include its retrospective nature, small sample size, imprecision in acuity measurements below 20/400, and lack of a control group. In this series, surgical intervention was associated with a modest improvement in median visual acuity up to 1 year postoperatively.
authors.affiliation: Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. h_f_fine@yahoo.com
authors.forename: Howard F
authors.initials: HF
authors.lastname: Fine
authors.forename: Reza
authors.initials: R
authors.lastname: Iranmanesh
authors.forename: Lucian V
authors.initials: LV
authors.lastname: Del Priore
authors.forename: Gaetano R
authors.initials: GR
authors.lastname: Barile
authors.forename: Louis K
authors.initials: LK
authors.lastname: Chang
authors.forename: Stanley
authors.initials: S
authors.lastname: Chang
authors.forename: William M
authors.initials: WM
authors.lastname: Schiff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D008297:Male; D011183:Postoperative Complications; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D005466:Fluorocarbons; D010959:Tissue Plasminogen Activator