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G. Velez, J.J. Weiter; Assessment and Comparison of Risk Factors in Subretinal Hemorrhages Associated with Choroidal Neovascularization and Suprachoroidal Hemorrhages . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4921.
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Purpose: We attempt to characterize and assess risk factors in the development of large surbretinal hemorrhages (SRH) in the context of choroidal neovascularization (CNVM) when compared to patients with spontaneous suprachoroidal hemorrhages (SCH. Methods: Records of 11 patients with the diagnosis of large SRH, defined as >6 disc diameter areas (DDA) and CNVM; and 6 patients with the diagnosis of spontaneous SCH, were retrospectively reviewed. Attention was paid to the following risk factors: advanced age, anticoagulant or anti-platelet therapy, hypertension, arteriosclerosis, diabetes, glaucoma, myopia, pseudophakia, recent ocular surgery, and size of the CNVM in eyes with SRH. Results: In both groups most patients were females, with an average age of 82 and 80 respectively. Patients with SRH had an average of 3.45 risk factors, those with SCH had an average of 5. CNVM was visible or assessed prior SRH in 9 eyes, and ranged from 4 to 16 DDA. The most common risk factors among eyes with SRH and CNVM (n= 11) were: advanced age (100%), hypertension (80%), anti-platelet therapy (70%), and arteriosclerosis (56%). There was little relationship between the CNVM and SRH size (correlation coefficient= 0.14). Among eyes with spontaneous SCH (n=6) these were: advanced age (100%) and arteriosclerosis (67%); anti-platelet therapy, hypertension, glaucoma, myopia and pseudophakia were all present in 50%. These results are consistent with data from the literature. Anticoagulation therapy was absent in the SRH group, and present in only 1 SCH patient (17%). Conclusions: As in SCH, systemic factors play an important role in the pathogenesis of large SRH. Unlike SCH, however, ocular risk factors play a less important role in eyes with large SRH. Discussions in the literature suggest that SRH in the context of CNVM occur as a result of weakness in the capillary beds of CNVM and the effect of neovascular growth factors. Our data suggests that vascular disease at the level of the choroid is the more likely source of large SRH. Damage to the RPE and Bruch's membrane, however, may further contribute to the development of large SRH.
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