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      Subretinal Hemorrhages Secondary to Age-Related Macular Degeneration: Psychological and Vision-Related Functional Perspectives

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          Purpose: To assess psychological, visual and functional aspects associated with subretinal hemorrhages secondary to age-related macular degeneration (AMD). Method: In this prospective, comparative, longitudinal study, 90 eyes of 90 patients with a subretinal hemorrhage, secondary to AMD, of at least 1 disk diameter were treated with recombinant tissue plasminogen activator (rTPA) and gas, and compared to 25 eyes of 25 controls. Outcome measures were: (1) visual acuity, (2) self-reported vision-related quality of life (Visual Function 14-item questionnaire) and (3)Hospital Anxiety and Depression (HAD) scores. Visual acuity and questionnaire responses were recorded prior to as well as 2 weeks and 4 months after treatment. Results: Improvements across objective visual acuity and vision-related functional measures, assessed at 2 weeks and 4 months, were significantly higher in patients who had rTPA and gas injections than in controls (p < 0.01). Patients were significantly more distressed at their 2-week follow-up in comparison to controls (HAD scores p < 0.01). Comparisons to controls showed no significant difference in psychological scores at the 4-month follow-up (p > 0.32). Conclusions: Patients with subretinal hemorrhages secondary to AMD are psychologically distressed as a result of acute loss of vision. More attention should be given to strategies that teach patients to cope with acute vision loss and thereby psychological disorder.

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          International experiences with the Hospital Anxiety and Depression Scale-A review of validation data and clinical results

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            Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement.

            To investigate the efficacy and safety of treating thick submacular hemorrhages with intravitreous tissue plasminogen activator (tPA) and pneumatic displacement. Retrospective, noncomparative case series. From 5 participating centers, 15 eligible patients had acute (<3 weeks) thick subretinal hemorrhage involving the center of the macula in eyes with pre-existing good visual acuity. Hemorrhages were secondary to age-related macular degeneration in 13 eyes and macroaneurysm and trauma in 1 eye each. The authors reviewed the medical records of 15 consecutive patients who received intravitreous injection of commercial tPA solution (25-100 microg in 0.1-0.2 ml) and expansile gas (0.3-0.4 ml of perfluoropropane or sulfur hexafluoride) for thrombolysis and displacement of submacular hemorrhage. After surgery, patients maintained prone positioning for 1 to 5 days (typically, 24 hours). Degree of blood displacement from under the fovea, best postoperative visual acuity, final postoperative visual acuity, and surgical complications. In 15 (100%) of 15 eyes, the procedure resulted in complete displacement of thick submacular hemorrhage out of the foveal area. Best postprocedure visual acuity improved by 2 lines or greater in 14 (93%) of 15 eyes. After a mean follow-up of 10.5 months (range, 4-19 months), final visual acuity improved by 2 lines or greater in 10 (67%) of 15 eyes and measured 20/80 or better in 6 (40%) of 15 eyes. Complications included breakthrough vitreous hemorrhage in three eyes and endophthalmitis in one eye. Four eyes developed recurrent hemorrhage 1 to 3 months after treatment, three of which were retreated with the same procedure. Intravitreous injection of tPA and gas followed by brief prone positioning is effective in displacing thick submacular blood and facilitating visual improvement in most patients. The rate of serious complications appears low. Final visual outcomes are limited by progression of the underlying macular disease in many patients.
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              Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions.

              To investigate the efficacy and safety of treating submacular hemorrhages secondary to age-related macular degeneration (ARMD) with intravitreous recombinant tissue plasminogen activator (rt-PA) and gas under various conditions. Prospective, noncomparative case series. Forty-three consecutive eyes of 42 patients with recent (range, 2-28 days) subfoveal hemorrhage secondary to ARMD were included in this study. The size of subretinal hemorrhage ranged from 0.25 to 30 disc areas. All patients were treated with intravitreous injections of rt-PA (50 microg) and sulfur hexafluoride (0.5 ml). Postoperative prone positioning was maintained for 24 to 72 hours. Patient follow-up ranged from 4 to 18 months (mean, 6 months). Best and final postoperative visual acuity in relation to size and onset of hemorrhage, displacement of subretinal blood, and surgical complications. Best postoperative visual acuity compared with preoperative visual acuity was improved two or more Snellen lines in 19 eyes (44%) and stable in 24 eyes (56%). Final visual acuity was improved two or more lines in 13 eyes (30%), stable in 26 (61%), and two or more lines worse in 4 eyes (9%). Duration of hemorrhage

                Author and article information

                S. Karger AG
                May 2008
                22 May 2008
                : 222
                : 3
                : 199-204
                aDepartment of Ophthalmology and bInstitute of Medical Statistics, Medical University of Vienna, Vienna, and cDepartment of Ophthalmology, Medical University of Graz, Graz, Austria
                126084 Ophthalmologica 2008;222:199–204
                © 2008 S. Karger AG, Basel

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                Page count
                Tables: 3, References: 32, Pages: 6
                Original Paper


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