Acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment in age-related macular degeneration: Case reports and literature review

Purpose: Acute angle-closure glaucoma resulting from massive subretinal hem orrhage is a rare and catastrophic complication in age-related macular dege neration. Anticoagulant usage had been strongly correlated with this compli cation in previously reported cases. Methods: Four patients (4 eyes), 3 men and 1 woman, developed angle-closure glaucoma with diffuse subretinal hemorrhage and total hemorrhagic retinal detachment. Results: Serial funduscopic examinations and echographic studies in 2 eyes showed that the blood gradually accumulated in the subretinal space. It too k more than 10 days for the bleeding to build up to bullous hemorrhagic ret inal detachment and secondary glaucoma. Antiglaucomatous agents were given and sclerotomy was performed in 3 of the 4 patients. Phthisical changes wer e observed subsequently in these 3 eyes. The eye that received early draina ge of blood was an exception, and a small degree of residual acuity was ret ained. Three of the 4 patients had diabetes mellitus, and hypertension and vascular diseases were also present in the same 3 patients. Conclusions: Diabetes mellitus might be a predisposing factor for the impai red hemostasis. Anti-glaucomatous agents were of no effect in the managemen t of intraocular pressure. Sclerotomy and drainage of blood help control in traocular pressure and relieve ocular pain. Poor final visual acuity is ine vitable. However, phthisical changes might be prevented with early scleroto my and drainage of blood. (C) Japanese Ophthalmological Society.