Retinal Hemorrhage in Macular Degeneration

An 82-year-old woman with a history of wet age-related macular degeneration in both eyes presented for a 3-month follow-up visit. She had previously undergone laser treatment for bilateral subretinal neovascular membranes. She has noticed a new black area in the vision of her left eye and periodic flashes of light in that eye.

Her best corrected visual acuity was finger counting at 4½ feet in the right eye and 20/30 in the left eye. Her intraocular pressures were normal in both eyes. Fundus examination of the left eye showed a large hypopigmented scar between the temporal aspect of the optic nerve head and the macula, a result of the laser therapy. There was also a new retinal hemorrhage located just nasal to the optic nerve head (A); the cause was presumed to be another subretinal neovascular membrane. Because the membrane did not threaten the macular area or the optic disc, the appropriate course of action was to monitor hemorrhage progression.

One month later, the patient reported that the dark spot in her vision was still present, but it was not any larger and may even have become smaller. The vision in her left eye had improved to 20/20. A fundus examination confirmed that the retinal hemorrhage had decreased in size (B). Three months after the original presentation, the patient's vision was stable in the left eye and her symptoms had diminished. Funduscopic examination revealed further retinal hemorrhage resorption (C).

Once a retinal hemorrhage is completely resorbed, a fluorescein angiogram can identify any underlying leaking neovascular vessels, which may then be treated with laser surgery.