Subretinal hemorrhage

Other rare complications that may lead to reduced visual acuity are subretinal pigment epithelial neovascularization, choroidal folds, preretinal macular hemorrhage, choroidal and subretinal hemorrhages, macular star formation, and retinal pigment epithelial disease. 

The visual acuity in posterior uveitis varies dramatically from case to case. Vitreitis, macular edema and/or exudate, subretinal neovascularization and/or hemorrhage, retinal detachment, and necrotic macular scarring may all serve to diminish acuity. In addition, the optic nerve may be involved in some infectious forms of posterior uveitis, such as toxoplasmosis, herpes, syphilis, or tuberculosis. Optic neuritis or neuroretinitis can further serve to compromise vision. 

ICGA is most valuable for evaluation of choroidal neovascularization. Fluorescein angiography of early choroidal fluorescence is potentially inhibited by media opacities, fundus pigmentation, xanthophyll, RPE, hemorrhage, or serous exudate in the retina. Rapid leakage from the fenestrated choroidal capillaries is sometimes not easily appreciated with fluorescein angiography in attempting to identify subretinal CNVMs. 

Of the cases in the VIP trial, the visual loss was attributed to the development of extensive subretinal fluid with choroidal hypofluorescence in one case and sub-retinal pigment epithelial hemorrhage in three cases. No obvious cause was detected in six cases. Vision recovered to < 20 letters lost in five of the 10 patients at three months after the events. Although preclinical studies demonstrated some damage to the RPE with PDT, the Phase III data did not suggest any increase in RPE atrophy in verte-porfin-treated patients. For both groups in the TAP study, the distribution of lesion sizes with the inclusion of surrounding atrophy did not differ from the distribution of lesion sizes without atrophy. 

Severe visual impairment. Large dark spot at or near center of vision. Large floating objects in eye. May see blood. External exam normal. Internal exam foveal retinal lesion(s) that may be obscured by vitreous hemorrhage. Foveal retinal burn, with vitreous or subretinal hemorrhage (Visible or near-infrared laser, high dose). Evacuate. Needs physician/PA evaluation. ... 

Subretinal hemorrhage - A collection of blood between the retina and the choroid. 

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