Abstract
Purpose
Submacular haemorrhage (SMH) is a cause of severe visual loss in neovascular age-related macular degeneration (nAMD). The incidence is uncertain and furthermore there is no widely used classification system nor agreed best practice. The aim of this national surveillance study was to identify the incidence, presenting features and clinical course of new fovea-involving submacular haemorrhage associated with nAMD.
Methods
A questionnaire was sent monthly to every ophthalmic specialist in Scotland over a 12-month period asking them to report all newly presenting patients with acute SMH secondary to nAMD of at least two disc diameters (DDs) in greatest linear diameter. A follow-up questionnaire was sent 6 months after initial presentation. Cases related to other causes were excluded.
Results
Twenty-nine cases were reported giving an incidence of 5.4 per million per annum (range 2–15). The mean age was 83 years (range 66–96) and females accounted for 17/29 (59%). Fifteen of the 29 cases (52%) had a past history of AMD, of which 7 had nAMD. Nineteen of the 29 cases (66%) presented within 7 days of onset and the majority had SMH of < 11 DD (20/29, 69%). Treatment options comprised the following: observation (n = 6, 21%), anti-VEGF alone (n = 6, 21%) or vitrectomy with co-application of tissue plasminogen activator (TPA), anti-VEGF and gas (n = 17, 58%). The vitrectomy group experienced the greatest change in vision from logMAR 1.89–1.50 (p = 0.374). Four of 20 (20%) cases with 6 months follow-up suffered a re-bleed at a mean time of 96 days.
Conclusions
The incidence, clinical features and course of a consecutive national cohort of patients with SMH secondary to nAMD are presented.
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Acknowledgements
We are very grateful for the opportunity to perform this project in conjunction with the Scottish Ophthalmic Surveillance Unit and wish to thank Mr Barny Foot for his valuable advice. We also acknowledge the contribution of the ophthalmologists throughout Scotland, who made this study possible by reporting cases to the SOSU and providing the necessary information about the patients.
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Al-Hity, A., Steel, D.H., Yorston, D. et al. Incidence of submacular haemorrhage (SMH) in Scotland: a Scottish Ophthalmic Surveillance Unit (SOSU) study. Eye 33, 486–491 (2019). https://doi.org/10.1038/s41433-018-0239-4
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DOI: https://doi.org/10.1038/s41433-018-0239-4
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