[Vitreous hemorrhage complicating age-related macular degeneration. Apropos of 18 cases]

Vitreous hemorrhage as a complication of Age-Related Macular Degeneration (ARMD) is not a frequent event: 19 cases (out of 18 patients) are reported, corresponding to 0.6% of the patients with ARMD seen in the Department of Ophthalmology of Créteil between January 1st, 1979 and December 31, 1986. The relation between ARMD and vitreous hemorrhage was easy to establish on fundus examination after the resorption of the hemorrhage. However, during the acute hemorrhagic phase, the diagnosis was helped by the other eye fundus examination: this second eye presented with ARMD lesions in 15 out of 18 cases (78.9%). The most challenging differential diagnosis was the choroidal melanoma, when a subretinal hematoma hindered all underlying structures. Vitreous hemorrhages originated generally from well developed subretinal new vessels (17 cases out of 19) arising from the choroid. A retinal pigment epithelium tear, spontaneous or secondary to photocoagulation, was suspected to be the cause of the vitreous hemorrhage in one eye. Finally drugs (3 cases) and systemic diseases (6 cases) seemed to play a role. Visual prognosis is poor in most cases, as the result of the destruction of the macular photoreceptors (six eyes only retained a visual acuity equal or better than 20/400). Laser photocoagulation of the subretinal new vessels was possible for 5 eyes and allowed stabilisation of visual acuity in 2 eyes and improvement in one eye. Vitreous hemorrhage cleared in 16 out of 19 during the follow-up period and vitrectomy was therefore not performed in our series and not indicated at early stages.