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Gerard F McGowan, David Steel, David Yorston; AMD with submacular hemorrhage: new insights from a population-based study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):662.
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To present the findings of a two centre, six month pilot study to determine the incidence of all new fovea involving large submacular haemorrhage
We conducted a novel 6 month pilot study in 2 centres, Sunderland and Glasgow (UK) to determine the incidence of all new, fovea involving, large submacular haemorrhages of greater than 2 disc diameters (greatest linear diameter). We collected data on presenting visual acuity, age, duration of symptoms, past ocular history, anticoagulant therapy, smoking status, management and visual outcome at 6 months.
Estimated Incidence of new large submacular haemorrhage: 25 per million per year. There was a wide range of presenting visual acuity (VA range: 6/9- HM. VA less than 3/60: 14/24, 3/60-6/60: 3/24, 6/60-6/18: 4/24, 6/18 or better: 3/24) age (range 49-92 median: 80), duration of symptoms (range 1-25 days median 9.6 days), past ocular history in affected eye (5/24 wet amd 3/24 dry amd i.e AntiVEGF naïve: 19/24), presence of anticoagulant therapy (9/24, (3 warfarin, 7 aspirin, 1 clopidogrel, 1 diclofenac) smokers (4/24 ex-smokers) and management: 3/24 observed, 9/24 antiVEGF, 6/24 PPV + subretinal tpa+ subretinal antiVEGF+ gas, 2/24 PPV + subretinal tpa + intravitreal antiVEGF + gas, 1/24 PPV + subretinal tpa+ gas, 1/24 expansile gas + intravitreal tpa + intravitreal antiVEGF, 1/24 expansile gas + intravitreal tpa. Vision remained stable or improved in all patients who underwent treatment.
As far as we are aware, we are the first group to estimate an incidence of new large submacular haemorrhage, 25 per million per year. Our results highlight the wide variety of management. On the basis of these results we secured a grant from the Scottish Ophthalmic Surveillance Unit (SOSU) to determine the true incidence of new large submacular haemorrhage. Scottish Ophthalmic Surveillance Unit: uses a structured, card reporting surveillance system to collect one year data on uncommon ophthalmic conditions in Scotland- study commrnenced November 2013. The cost of antiVEGF therapy is considerable and submacular haemorrhage may be an important cause of treatment failure. Identifying the true incidence of this condition and developing improved treatments has obvious implications for public health and health economics. We believe that this study could be a vital step towards identifying a gold standard treatment for submacular haemorrhage
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