Natural history of macular subretinal hemorrhage in age-related macular degeneration

Purpose: To define the natural course of extensive submacular hemorrhage in age-related macular degeneration (AMD). Patients and Methods: The clinical charts of 54 patients (60 eyes) older than 55 years with subretinal hemorr hage larger than 1 disk diameter and extending beneath the fovea were retro spectively reviewed. The age of the patient, the use of antihypertensive or anticoagulant medication, visual acuity, biomicroscopic and fluorescein an d indocyanine green (in 33 cases) angiographic data were recorded at presen tation and during follow-up. Results: At the initial examination, average v isual acuity was 20/240 (range from 20/70 to light perception). During foll ow-up (mean 24 months) visual acuity worsened in 80% of the eyes with a mea n final visual acuity of 20/1,250 (range from 20/100 to light perception). The initial size and thickness of hemorrhage were correlated with initial a nd final visual acuity. Recurrence of hemorrhage resulted in an important i mpact on final visual acuity. Anatomic outcome showed fibrous tissue prolif eration in 23 eyes (38.3%), atrophic scar in 15 eyes (25%) and occurrence o f a retinal pigment epithelium tear in 13 eyes (21.6%). Conclusion: The vis ual outcome in eyes with submacular hemorrhages due to AMD is very poor. Si ze and thickness of the hemorrhage influenced negatively the natural progno sis. A surgical approach can be considered although it has not yet a widesp read use.