gms | German Medical Science

25th Annual Meeting of the German Retina Society

German Retina Society

01.06. - 02.06.2012, Münster

AMD with concurrent hemorrhages: specific features and classification

Meeting Abstract

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  • Silvia Bopp - Augenklinik Universitätsallee, Bremen

German Retina Society. 25th Annual Conference of the German Retina Society. Münster, 01.-02.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12rg40

doi: 10.3205/12rg40, urn:nbn:de:0183-12rg402

This is the English version of the article.
The German version can be found at:

Published: May 30, 2012

© 2012 Bopp.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Visual prognosis decreases significantly when exudative AMD is complicated by hemorrhages. The present report discusses the peculiarities of hemorrhagic AMD with respect to the clinical course and treatment options.

Methods: Based on our patient data the following questions are addressed.

When considering the heterogeneous clinical presentation, which therapy is indicated in which situation?
Why are results after medial and surgical treatment often unsatisfactorily?
Why do we need a classification for subretinal hemorrhages in AMD?

Results: About 10% of eyes that present for initial therapy of exudative AMD show concurrent hemorrhages of varying extent. Furthermore, recurrent bleeding is frequent.

CNV with spotty hemorrhages or bleedings at their margin are usually treated by anti-VEGF only. Treatment of larger hemorrhages, however, has remained controversial. In clinical practice, decision-making is based on rationales and personal experience. Except for the SST, no randomized studies are available.
Histopathologic studies show complex pathologies of the CNV and adjacent structures (e.g. photoreceptor cells, RPE, Bruchs membrane and choriocapillaris). Hemorrhages lead to even more serious alterations. As bleeding most often occur in occult-type membranes, the sub-RPE space often is affected. Anti-VEGF therapy aims at control of the CNV, but has no impact on the hemorrhagic component. Surgery to dislocate blood from the fovea has proven to be insufficient when sub-RPE blood is present and carries a high risk of RIP formation.
A major difficulty in comparing different treatment modalities for larger hemorrhages is the lack of standardized definition subretinal blood. As current imaging techniques allow quantification and localization of the hemorrhagic component, the author suggests a classification system for subretinal hemorrhages in AMD, which may be useful for clinical practice and future studies.

Conclusions: AMD with concurrent hemorrhages is a “nasty” subtyp. Despite of numerous treatment options available, the prognosis is dubious. Outcomes after medical and surgical treatment are poor. Furthermore, the risk/benefit ratio of surgical methods is ill-defined and requires reevaluation