Incidence of submacular haemorrhage (SMH) in Scotland: a Scottish Ophthalmic Surveillance Unit (SOSU) study

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.

Incidence, risk factors and outcomes of submacular haemorrhage with loss of vision in neovascular age‐related macular degeneration in daily clinical practice: data from the FRB! registry

“…Few studies have investigated the incidence and rate of this uncommon and potentially severe complication of nAMD. A nationwide prospective observational study using SOSU (Scottish Ophthalmic Surveillance Unit) found an overall incidence of 5.4 SMH (defined as all newly diagnosed cases of fovea-involving SMH of size >2 disc diameters) per million per annum (Al-Hity et al 2019). In relation to the number of patients with exudative AMD (about 1.4% of the population of Europe), this rate (about 5.4 per 14 000 versus 64 per 14 000 in our study) is somewhat lower than in our study (Li et al 2020).…”

Retinal Hemorrhage after SARS-CoV-2 Vaccination

“…Many of our patients were referrals from other centers (our institute is one of the largest tertiary centers in Korea), but the high number of patients with RVO and AMD-related submacular hemorrhage encountered within a short period (~4 months) indicates that these uncommon pathologies did not develop by chance. Submacular hemorrhage is known to occur in 5.4 per million, which indicates that this is not a condition seen every day in a retina clinic [ 26 ]. According to a study including 791 newly diagnosed neovascular AMD patients, 129 eyes (16.3%) exhibited submacular hemorrhage at initial presentation, and the incidence of submacular hemorrhage was greater in PCV (23.6%, 78 of 330 eyes) than in typical neovascular AMD (9.4%, 28 of 297 eyes) [ 27 ].…”

Treatment of submacular hemorrhage with tissue plasminogen activator and pneumatic displacement in age-related macular degeneration

“…To account for this, the size of macular hemorrhage was also assessed using color fundal photographs based on following modified criteria (example shown in Figure 2): small (from one optic nerve disk diameter to four optic nerve disk diameters), medium (larger than four optic nerve disk diameters, but within temporal vessel arcades), and massive (hemorrhage extending beyond temporal arcades). 14…”