Pathophysiology and management of subretinal hemorrhage

Surv Ophthalmol. Nov-Dec 1997;42(3):195-213. doi: 10.1016/s0039-6257(97)00089-1.

Abstract

Subretinal hemorrhage can arise from the retinal and/or choroidal circulation. Significant subretinal hemorrhage occurs in several conditions, but most commonly is associated with age-related macular degeneration, presumed ocular histoplasmosis, high myopia, retinal arterial macroaneurysm, and trauma. Released toxins, outer retinal shear forces, and a diffusion barrier created by subretinal hemorrhage all contribute to photoreceptor damage and visual loss. The use of tissue plasminogen activator and improvements in surgical instrumentation have facilitated surgical drainage and have made it a useful option in the management of selected cases. Mechanisms of subretinal hemorrhage formation, underlying etiologies, diagnostic evaluation, and the histopathology of damage are summarized. Published surgical series are reviewed and surgical advances are summarized. The value of surgically removing subretinal hemorrhages to improve visual outcome remains unestablished, because definitive studies have not been performed. Guidelines for selecting candidates for surgical intervention are proposed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Choroid / blood supply
  • Drainage
  • Fluorescein Angiography
  • Fundus Oculi
  • Humans
  • Macular Degeneration / complications
  • Neovascularization, Pathologic / complications
  • Prognosis
  • Retinal Hemorrhage / etiology
  • Retinal Hemorrhage / physiopathology*
  • Retinal Hemorrhage / therapy*
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / therapeutic use
  • Vitrectomy

Substances

  • Tissue Plasminogen Activator