Skip to main content

Advertisement

Log in

Visual prognosis of eyes with submacular hemorrhage associated with exudative age-related macular degeneration

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To study the retinal structural changes associated with submacular hemorrhage due to exudative age-related macular degeneration (AMD) and their relationships with visual prognosis.

Methods

We retrospectively reviewed the medical records of 31 consecutive patients (31 eyes) with visual impairment due to an acute submacular hemorrhage associated with typical AMD (10 eyes) or polypoidal choroidal vasculopathy (21 eyes).

Results

Optical coherence tomography (OCT) revealed that submacular hemorrhage exhibited intense hyperreflectivity beneath the neurosensory retina and often seemed to infiltrate it. In the OCT sections, mild to moderate amorphous hyperreflectivity and/or hyperreflective dots were observed within the neurosensory retina, resulting in the loss of the junctions between the inner (IS) and outer (OS) segments of the photoreceptors. Of the 31 eyes, the foveal IS/OS line could be seen incompletely in 12 eyes and was totally absent in 16 eyes. The initial integrity of the foveal photoreceptor layer was correlated with the final visual acuity; the initial detection of the IS/OS just beneath the fovea was correlated with good final visual acuity (r = 0.375, p = 0.038).

Conclusion

As a hallmark of integrity of the foveal photoreceptor layer, the initial detection of the IS/OS just beneath the fovea may predict good visual outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Woo JJ, Lou PL, Ryan EA, Kroll AJ. Surgical treatment of submacular hemorrhage in age-related macular degeneration. Int Ophthalmol Clin. 2004;44:43–50.

    Article  PubMed  Google Scholar 

  2. Steel DH, Sandhu SS. Submacular haemorrhages associated with neovascular age-related macular degeneration. Br J Ophthalmol. 2011;95:1051–7.

    Article  PubMed  Google Scholar 

  3. Bennett SR, Folk JC, Blodi CF, Klugman M. Factors prognostic of visual outcome in patients with subretinal hemorrhage. Am J Ophthalmol. 1990;109:33–7.

    PubMed  CAS  Google Scholar 

  4. Avery RL, Fekrat S, Hawkins BS, Bressler NM. Natural history of subfoveal subretinal hemorrhage in age-related macular degeneration. Retina. 1996;16:183–9.

    Article  PubMed  CAS  Google Scholar 

  5. Berrocal MH, Lewis ML, Flynn HW Jr. Variations in the clinical course of submacular hemorrhage. Am J Ophthalmol. 1996;122:486–93.

    PubMed  CAS  Google Scholar 

  6. Scupola A, Coscas G, Soubrane G, Balestrazzi E. Natural history of macular subretinal hemorrhage in age-related macular degeneration. Ophthalmologica. 1999;213:97–102.

    Article  PubMed  CAS  Google Scholar 

  7. de Juan E, Jr Machemer R. Vitreous surgery for hemorrhagic and fibrous complications of age-related macular degeneration. Am J Ophthalmol. 1988;105:25–9.

    PubMed  Google Scholar 

  8. Wade EC, Flynn HW Jr, Olsen KR, Blumenkranz MS, Nicholson DH. Subretinal hemorrhage management by pars plana vitrectomy and internal drainage. Arch Ophthalmol. 1990;108:973–8.

    Article  PubMed  CAS  Google Scholar 

  9. Stifter E, Michels S, Prager F, Georgopoulos M, Polak K, Hirn C, et al. Intravitreal bevacizumab therapy for neovascular age-related macular degeneration with large submacular hemorrhage. Am J Ophthalmol. 2007;144:886–92.

    Article  PubMed  CAS  Google Scholar 

  10. Fine HF, Iranmanesh R, Del Priore LV, Barile GR, Chang LK, Chang S, et al. Surgical outcomes after massive subretinal hemorrhage secondary to age-related macular degeneration. Retina. 2010;30:1588–94.

    Article  PubMed  Google Scholar 

  11. Ohji M, Saito Y, Hayashi A, Lewis JM, Tano Y. Pneumatic displacement of subretinal hemorrhage without tissue plasminogen activator. Arch Ophthalmol. 1998;116:1326–32.

    PubMed  CAS  Google Scholar 

  12. Kamei M, Tano Y, Maeno T, Ikuno Y, Mitsuda H, Yuasa T. Surgical removal of submacular hemorrhage using tissue plasminogen activator and perfluorocarbon liquid. Am J Ophthalmol. 1996;121:267–75.

    PubMed  CAS  Google Scholar 

  13. Lim JI, Drews-Botsch C, Sternberg P Jr, Capone A Jr, Aaberg TM Sr. Submacular hemorrhage removal. Ophthalmology. 1995;102:1393–9.

    PubMed  CAS  Google Scholar 

  14. Hassan AS, Johnson MW, Schneiderman TE, Regillo CD, Tornambe PE, Poliner LS, et al. Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement. Ophthalmology. 1999;106:1900–6.

    Article  PubMed  CAS  Google Scholar 

  15. Tsujikawa A, Sakamoto A, Ota M, Oh H, Miyamoto K, Kita M, et al. Retinal structural changes associated with retinal arterial macroaneurysm examined with optical coherence tomography. Retina. 2009;29:782–92.

    Article  PubMed  Google Scholar 

  16. Green WR, Key SN 3rd. Senile macular degeneration: a histopathologic study. Trans Am Ophthalmol Soc. 1977;75:180–254.

    PubMed  CAS  Google Scholar 

  17. Reynders S, Lafaut BA, Aisenbrey S, Broecke CV, Lucke K, Walter P, et al. Clinicopathologic correlation in hemorrhagic age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2002;240:279–85.

    Article  PubMed  CAS  Google Scholar 

  18. Glatt H, Machemer R. Experimental subretinal hemorrhage in rabbits. Am J Ophthalmol. 1982;94:762–73.

    Article  PubMed  CAS  Google Scholar 

  19. Toth CA, Morse LS, Hjelmeland LM, Landers MB 3rd. Fibrin directs early retinal damage after experimental subretinal hemorrhage. Arch Ophthalmol. 1991;109:723–9.

    Article  PubMed  CAS  Google Scholar 

  20. Koshibu A. Ultrastructural studies on absorption of an experimentally produced subretinal hemorrhage. III. Absorption of erythrocyte break down products and retinal hemosiderosis at the late stage. Nippon Ganka Gakkai Zasshi. 1979;83:386–400. (in Japanese).

    PubMed  CAS  Google Scholar 

  21. el Baba F, Jarrett WH 2nd, Harbin TS Jr, Fine SL, Michels RG, Schachat AP, et al. Massive hemorrhage complicating age-related macular degeneration. Clinicopathologic correlation and role of anticoagulants. Ophthalmology. 1986;93:1581–92.

    PubMed  Google Scholar 

  22. Drexler W, Sattmann H, Hermann B, Ko TH, Stur M, Unterhuber A, et al. Enhanced visualization of macular pathology with the use of ultrahigh-resolution optical coherence tomography. Arch Ophthalmol. 2003;121:695–706.

    Article  PubMed  Google Scholar 

  23. Ko TH, Fujimoto JG, Schuman JS, Paunescu LA, Kowalevicz AM, Hartl I, et al. Comparison of ultrahigh- and standard-resolution optical coherence tomography for imaging macular pathology. Ophthalmology. 2005;112:1922–35.

    Article  PubMed  Google Scholar 

  24. Wojtkowski M, Bajraszewski T, Gorczynska I, Targowski P, Kowalczyk A, Wasilewski W, et al. Ophthalmic imaging by spectral optical coherence tomography. Am J Ophthalmol. 2004;138:412–9.

    Article  PubMed  Google Scholar 

  25. Chen TC, Cense B, Pierce MC, Nassif N, Park BH, Yun SH, et al. Spectral domain optical coherence tomography: ultra-high speed, ultra-high resolution ophthalmic imaging. Arch Ophthalmol. 2005;123:1715–20.

    Article  PubMed  Google Scholar 

  26. Coscas F, Coscas G, Souied E, Tick S, Soubrane G. Optical coherence tomography identification of occult choroidal neovascularization in age-related macular degeneration. Am J Ophthalmol. 2007;144:592–9.

    Article  PubMed  Google Scholar 

  27. Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi CI. Clinical features and natural history of AMD. In: Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi CI, editors. Optical coherence tomography in age-related macular degeneration. Heidelberg: Springer, 2009. p. 171–274.

  28. Mavrofrides EC, Villate N, Rosenfeld PJ, Puliafito CA. Age-related macular degeneration. 2nd ed. In: Schuman JS, Puliafito CA, Fujimoto JG, editors. Optical coherence tomography. Thorofare: Slack; 2004. p. 243–344.

  29. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.

    Article  PubMed  CAS  Google Scholar 

  30. Spaide RF. Central serous chorioretinopathy. In: Holz FG, Spaide RF, editors. Medical retina. Berlin: Springer; 2004. p. 77–93.

    Google Scholar 

  31. Lincoff H, Madjarov B, Lincoff N, Movshovich A, Saxena S, Coleman DJ, et al. Pathogenesis of the vitreous cloud emanating from subretinal hemorrhage. Arch Ophthalmol. 2003;121:91–6.

    Article  PubMed  Google Scholar 

  32. Ooto S, Tsujikawa A, Mori S, Tamura H, Yamashiro K, Otani A, et al. Retinal microstructural abnormalities in central serous chorioretinopathy and polypoidal choroidal vasculopathy. Retina. 2011;31:527–34.

    Article  PubMed  Google Scholar 

  33. Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi CI. OCT interpretation. In: Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi CI, editors. Optical coherence tomography in age-related macular degeneration. Heidelberg: Springer; 2009. p. 97–170.

  34. Marmor MF. Mechanisms of fluid accumulation in retinal edema. Doc Ophthalmol. 1999;97:239–49.

    Article  PubMed  CAS  Google Scholar 

  35. Costa RA, Calucci D, Skaf M, Cardillo JA, Castro JC, Melo LA Jr, et al. Optical coherence tomography 3: automatic delineation of the outer neural retinal boundary and its influence on retinal thickness measurements. Invest Ophthalmol Vis Sci. 2004;45:2399–406.

    Article  PubMed  Google Scholar 

  36. Hayashi H, Yamashiro K, Tsujikawa A, Ota M, Otani A, Yoshimura N. Association between foveal photoreceptor integrity and visual outcome in neovascular age-related macular degeneration. Am J Ophthalmol. 2009;148:83–9.

    Article  PubMed  Google Scholar 

  37. Oishi A, Hata M, Shimozono M, Mandai M, Nishida A, Kurimoto Y. The significance of external limiting membrane status for visual acuity in age-related macular degeneration. Am J Ophthalmol. 2010;150:27–32.

    Article  PubMed  Google Scholar 

  38. Sandberg MA, Brockhurst RJ, Gaudio AR, Berson EL. The association between visual acuity and central retinal thickness in retinitis pigmentosa. Invest Ophthalmol Vis Sci. 2005;46:3349–54.

    Article  PubMed  Google Scholar 

  39. Bhisitkul RB, Winn BJ, Lee OT, Wong J, Pereira Dde S, Porco TC, et al. Neuroprotective effect of intravitreal triamcinolone acetonide against photoreceptor apoptosis in a rabbit model of subretinal hemorrhage. Invest Ophthalmol Vis Sci. 2008;49:4071–7.

    Article  PubMed  Google Scholar 

  40. Kim KS, Lee WK. Bevacizumab for serous changes originating from a persistent branching vascular network following photodynamic therapy for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2011;55:370–7.

    Article  PubMed  CAS  Google Scholar 

  41. Nakata I, Yamashiro K, Nakanishi H, Tsujikawa A, Otani A, Yoshimura N. VEGF gene polymorphism and response to intravitreal bevacizumab and triple therapy in age-related macular degeneration. Jpn J Ophthalmol. 2011;55:435–43.

    Article  PubMed  CAS  Google Scholar 

  42. Akaza E, Yuzawa M, Mori R. Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2011;55:39–44.

    Article  PubMed  CAS  Google Scholar 

  43. Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T, et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003;121:1392–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Akitaka Tsujikawa.

About this article

Cite this article

Ueda-Arakawa, N., Tsujikawa, A., Yamashiro, K. et al. Visual prognosis of eyes with submacular hemorrhage associated with exudative age-related macular degeneration. Jpn J Ophthalmol 56, 589–598 (2012). https://doi.org/10.1007/s10384-012-0191-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-012-0191-y

Keywords

Navigation