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V. Marthelot, G. Coscas, G. Soubrane; Lesions Responsible of Subretinal Haemorrhages in Age-related Macular Degeneration(armd) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1750.
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Purpose: Angiographic identification of choroidal new vessel (CNV) associated to subretinal haemorrhages in ARMD; evaluation of prognostic factors. Methodology: Retrospective study of patients examined from June 1996 to November 2002. Clinical examination, biomicroscopy and angiographies were reviewed before haemorrhage, at presentation and during follow up. Results: 19 patients were male, 33 female (62 eyes). Age range from 66 to 93 years. 64.5% of the patients were treated with antihypertensive medication, 30.5% with anti-platelet aggregation medication and 9% with anticoagulants. At the occurrence of the haematoma (mean GLD 3.9 disk diameter), initial visual acuity was 20/164 (score 19 letters EDTRS). Fluorescein and indocyanine green angiographies disclosed occult CNV in 49 eyes (80.3%, including 7 mixed lesions), classic CNV in 3 cases, pigment epithelial detachment in 2 cases which 1 case with choriodoretinal anastomosis and 1 case obscured by vitreous haemorrhage. The management consisted of laser photocoagulation in 21 eyes, phototherapy dynamic in 8 eyes, pneumatic displacement in 5 cases, anecortave acetate injection in 1 case and follow up in 23 cases. The average final acuity was 20/228 (score 24 letters EDTRS). 7 eyes gained 3 lines EDTRS or more (mean of 6 lines), 15 eyes lost 2 lines or more (mean of 5 lines) and visual acuity was stable in 19 eyes. The final evolution resulted in an important fibrovascular scar in 20 cases, persistent occult CNV in 12 cases, retinal pigment epithelial tear in 9 cases and persistent haemorrhage in 7 cases. Conclusion: Subepithelial haemorrhages in ARMD are mainly caused by occult CNV in our study in 49 of the 52 cases where angiographies could be analysed. The visual prognosis is poor and is not correlated neither with haematoma initial size, nor with therapeutic management (p≥0.05).
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