ACUTE GLAUCOMA IN AGE-RELATED MACULAR DEG ENERATION DUE TO SUBRETINALHEMORRHAGE AND DISORDER OF PLATELET-FUNCTION

Background Hemorrhages from subretinal neovascularisations in age-rela ted macular degeneration are not uncommon, but usually limited to the posterior pole. A therapy-resistant angle closure glaucoma following d isplacement of the lens-iris diaphragm due to massive choroidal and su bretinal hemorrhages has rarely been reported. Case report A 72-year-o ld female patient was first seen in september 1993 because of decrease d vision in the right eye. An age related macular degeneration with an extended untreatable neovascularisation membrane was diagnosed. One y ear later sudden pain attacks were initiated by secondary angle closur e glaucoma, caused by a massive choroidal and subretinal bleeding. At first the IOP could be regulated by drug therapy, however, recurring h emorrhages led to continuously elevated IOP. The reason for the recurr ent massive hemorrhages was found to be a disorder of the platelet fun ction. Since the IOP (50-80 mmHg) could not be controlled any further, we decided to perform a sclerotomy in an attempt to drain the blood. Within one day another bleeding occurred and again led to an increase in IOP. Finally, the patient agreed to have the eye enucleated. Conclu sion In case of massive hemorrhages in age related macular degeneratio n a haematological systemic disorder must be included in the diagnosti c considerations. If the intraocular pressure can not be lowered neith er medically nor surgically, enucleation can not be avoided.