Original articleSubretinal Hemorrhages Associated with Age-Related Macular Degeneration in Patients Receiving Anticoagulation or Antiplatelet Therapy
Section snippets
Methods
We retrospectively reviewed the medical and photographic records of 71 consecutive patients who sought treatment at our institution with subretinal hemorrhages complicating AMD. All patients had acute hemorrhages (< 1 week old) and reading vision in the affected eye before the onset of hemorrhage. If both eyes of the same patient met the inclusion criteria, only the first affected eye was selected for further analysis to avoid possible bias. Patients were excluded whenever pathologic myopia,
Results
Seventy-one patients (71 eyes; 25 males and 46 females; mean age, 75.8 years; range, 50 to 94 years) were included in the study. The mean size of subretinal hemorrhages was 5.63 disc areas (range, 0.1 to 32 disc areas; median, 1.5 disc areas). The mean hemorrhage size among patients with severe subretinal hemorrhages (≥ 4.5 disc areas) was 14.1 MPS disc areas (range, 5 to 32 MPS disc areas; median, 10.0 disc areas) compared with a mean hemorrhage size of 1.1 MPS disc areas (range, 0.1 to 4.0
Discussion
Severe submacular hemorrhage, particularly in patients with AMD, generally is associated with a poor visual outcome.2, 3 Several potential mechanisms have been proposed to explain the visual acuity loss in eyes with subretinal hemorrhage. Animal studies have shown that photoreceptors degenerate in fewer than 24 hours with pyknosis of the outer nuclear layer.23 Other mechanisms of damage may include clot retraction, iron toxicity, and blockage of nutrient diffusion.24, 25 According to
Claudia Kuhli-Hattenbach, MD, graduated from the Johann Wolfgang Goethe-University in Frankfurt am Main, Germany, and underwent ophthalmology training at the Frankfurt University Eye Hospital. Dr. Kuhli-Hattenbach completed her residency and is currently specializing in pediatric ophthalmology and strabismus. Her main research interests include systemic risk factors and coagulation diasorders in ocular vascular occlusive diseases.
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Claudia Kuhli-Hattenbach, MD, graduated from the Johann Wolfgang Goethe-University in Frankfurt am Main, Germany, and underwent ophthalmology training at the Frankfurt University Eye Hospital. Dr. Kuhli-Hattenbach completed her residency and is currently specializing in pediatric ophthalmology and strabismus. Her main research interests include systemic risk factors and coagulation diasorders in ocular vascular occlusive diseases.