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Neeta Varshney, Atul Jain, Vicki Chan, David Sarraf; Underlying Pathologies in Severe Macular Hemorrhage Due to Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5167.
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The purpose of this study was to assess the underlying pathology in treatment-naive eyes with exudative age-related macular degeneration (AMD) presenting with severe macular hemorrhage (greater than 50% of the area of choroidal neovascularization obscured by hemorrhage on fluorescein angiography).
The authors performed a retrospective review of consecutive eyes that presented with severe macular hemorrhage over a 3.3 year period (May 2006 to September 2009) at a single center. Intravitreal injections of Avastin (becacizumab) and Lucentis (ranibizumab) were administered until the hemorrhage completely resolved. Fundus photography, fluorescein angiography, and optical coherence topography were studied for each case of severe macular hemorrhage both before treatment was initiated and after complete resolution of the hemorrhage.
Twenty eyes from 20 patients were evaluated in this study. Anatomical outcomes assessed after resolution of the severe macular hemorrhage revealed: 5 eyes with underlying disciform macular scars, 7 eyes with RPE (retinal pigment epithelium) tears, 5 eyes with regressed choroidal neovascularization, and 3 eyes with collapsed PEDs (pigment epithelium detachments). Visual acuity at presentation was 20/700 (logMAR 1.55) and visual acuity after resolution of hemorrhage was significantly improved at 20/100 (logMAR 0.7), with p< 0.001. Of the eyes with RPE tears, 3 were newly diagnosed Grade 2 tears, 3 were newly diagnosed Grade 3 tears, and one was a known Grade 2 tear that extended to Grade 3 under treatment.
This study is the first to document a high degree of association of RPE tears (35%) with severe macular hemorrhage in wet AMD. VA improved after treatment with anti-VEGF agents in both eyes with and without RPE tears. Eyes with RPE tears required prolonged treatment for the macular hemorrhage to clear compared to eyes without tears.
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