Purchase this article with an account.
R. Iranmanesh, W.M. Schiff, L.V. Del Priore; Surgical Management of Patients with Massive Subretinal Hemorrhage Secondary to Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5261.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the outcomes of surgical management in patients with massive subretinal hemorrhage secondary to age–related macular degeneration (AMD).
Twelve eyes of 10 patients were identified from a retrospective review of all patients who underwent surgery for massive subretinal hemorrhage (extending to the equator in 2 or more quadrants) secondary to AMD. All patients were managed surgically with either pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (TPA) and gas or with PPV, 180 to 360 degree retinotomy, subretinal clot removal and gas or silicone oil tamponade. Visual and anatomic results were evaluated.
Preoperative visual acuity (VA) ranged from counting fingers (CF) to light perception (LP). Postoperative VA ranged from 20/400 to no light perception (NLP). Ten of twelve eyes (83%) had either maintained or improved postoperative VA and 6/10 patients had ambulatory vision with a mean follow up of 8.5 months (range 3 to 24 months). Ultimately, 9/12 eyes required 2 or more surgeries to achieve anatomic success. Patients who had subretinal TPA and required repeat surgical intervention within 7–10 days due to vitreous hemorrhage, hyphema, and/or elevated IOP achieved a final better visual result, possible because the subretinal blood could be removed more completely during the second surgical procedure. Complications resulted in loss of vision in 2 patients. One patient developed NLP vision secondary to uncontrolled postoperative glaucoma and another patient had postoperative retinal detachment but declined further intervention.
Surgical intervention for massive subretinal hemorrhage from AMD may lead to anatomic and visual improvement with the majority of patients regaining ambulatory vision. Patients who have two procedures within a short period of time may have a better prognosis, possible due to the ability to remove subretinal blood more completely during the second procedure when TPA is used initially.
This PDF is available to Subscribers Only