Wet Age-Related Macular Degeneration

A 69-year-old woman experienced a sudden, painless loss of vision in her left eye. Her ocular history included early cataracts and macular degeneration.

Funduscopic examination of the left eye showed scattered drusen (yellow-white spots) in the posterior pole and a hemorrhagic retinal pigment epithelial detachment that resulted from rupture of an underlying choroidal neovascular membrane. This manifests as blood confined to the subretinal pigment epithelial space and appears as a very dark red, almost black, elevated mound. This dark area was surrounded by a hemorrhagic neurosensory retinal layer detachment that developed as the blood broke through into the subretinal space. One or 2 weeks after the initial bleeding, the surrounding hemorrhage became red (A).

Fluorescein angiography was unable to localize the choroidal neovascular membrane because of the overlapping hemorrhage; thus, laser treatment would be of no benefit. Gradual organization of the blood and further ingrowth of new vessels from the choroid follows these hemorrhagic episodes. Eventually, a fibrous, disciform scar at the fovea causes permanent loss of central vision, as seen in another patient with this condition (B).

There are 2 types of age-related macular degeneration (ARMD):

• Nonexudative, dry, or atrophic disease accounts for 90% of cases.
• The exudative, wet, or neovascular form, which affected this patient, occurs in 10% of persons with ARMD.

Wet ARMD is responsible for 90% of severe visual loss in all patients with macular degeneration.¹

Argon laser photocoagulation or photodynamic therapy is recommended for classic subfoveal choroidal neovascularization only if the lesion has a well-demarcated boundary and is accessible because it is not obscured by blood.

REFERENCE:1. Skorin L. Age-related macular degeneration. In: Onofrey BE, Skorin L, Holdeman NR, eds. Ocular Therapeutics Handbook: A Clinical Manual. Philadelphia: Lippincott-Raven; 1998:440-443.