Factors prognostic of Visual Outcome in Patients with Subretinal Hemorrhage

Abstract

Maslim J, et al. Limiting photoreceptor death and deconstruction during experimental retinal detachment: the value of oxygen supplementation. Am J Ophthalmol 1999;128:155-164. PURPOSE: To investigate the ocular manifestations of patients with severe acute respiratory syndrome (SARS) and to monitor the possible ocular complications arising from the treatment regimen with high-dose systemic corticosteroid drugs. DESIGN: Prospective, observational cohort case series. METHODS: Ninety eyes from 45 patients with the diagnosis of SARS during an epidemic outbreak in Hong Kong were analyzed. Relevant medical and ophthalmic histories were taken. Ophthalmic examinations, including best-corrected visual acuity, intraocular pressure, slitlamp, and indirect ophthalmoscopy examination, were performed at baseline and at 2-month and 3-month follow-up. SETTING: Faculty practice in university hospital. RESULTS: Only two patients had mild elevated intraocular pressure at baseline and at subsequent follow-up. There was no loss of visual acuity, cataract progression, or increased cup-disk ratio. Fundus examinations were unremarkable in all patients. CONCLUSIONS: Our study did not demonstrate any ocular manifestations in patients with SARS. The treatment regimen of high-dose corticosteroid also did not show any significant ocular complications. Routine ocular screening of patients with SARS for diagnosis or for complications might not be indicated. (Am J Ophthalmol 2004; 137:773-774.

Vitrectomy with subretinal tissue plasminogen activator and ranibizumab for submacular haemorrhages secondary to age-related macular degeneration: retrospective case series of 45 consecutive cases

“…1,2 The subretinal blood is a barrier to diffusion of oxygen from the choroid; contraction of the blood clot damages the photoreceptors; and the iron in the haemoglobin is toxic. 3 Bennett et al 4 found that patients with submacular haemorrhage associated with AMD involving the fovea had a mean visual acuity of 20/1700 at final follow-up. A number of interventions have been proposed, including intravitreal anti-VEGF alone, 5,6 intravitreal anti-VEGF combined with intravitreal gas and/or recombinant tissue plasminogen activator (rtPA), 7,8 and vitrectomy with subretinal rtPA and anti-VEGF.…”

Early treatment of acute submacular haemorrhage secondary to wet AMD using intravitreal tissue plasminogen activator, C3F8, and an anti-VEGF agent

“…The natural history of this condition is severe, with few patients showing much improvement in visual acuity. 1,2 Accumulation of blood in the subretinal space has been shown in experimental models to cause photoreceptor damage within 24 h, 3 and this may be because of shearing of photoreceptor outer segments, impaired transport of nutrients, and direct iron toxicity derived from haemoglobin. [2][3][4] Therefore, timely intervention is required.…”

Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration

“…[1][2][3] Vitreoretinal surgery to remove subretinal blood secondary to neovascular AMD is associated with various complications including damage of retinal pigment epithelium. [4][5][6][7][8][9] Pharmacologically induced fibrinolysis does not significantly improve visual outcome.…”