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Subretinal/Submacular Haemorrhage

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Ophthalmic Signs in Practice of Medicine

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Abstract

Haemorrhage under the neurosensory retina or the retinal pigment epithelium in the macula is a sight-threatening condition. It is a significant public health concern in the ageing population the world over. The varying severity of haemorrhage from the rupture of the new vessels of choroidal origin compromises central vision that may go unnoticed in the first eye. Two distinct variants are seen. Stigmata of age-related macular degeneration (AMD) in the form of drusen and pigmentary changes accompany bilateral disease in the Caucasian population. In contrast, the one in the Asian population often presents with unilateral features and can become bilateral lateris characterized by a network of vessels and the formation of polyps under the RPE that cause massive haemorrhagic pigment epithelial detachments (polypoidal choroidal vasculopathy, PCV). Moreover, AMD is characterized by age-related thinning of choroid and ischemia, while PCV has a thick and hyperpermeable choroid.

There is evidence that polymorphisms in the alternate complement pathways lead to low-grade inflammation and interfere with the debris removal pathways. Smoking, a strong epigenetic factor, increasesthe risk of age-related macular degeneration several folds in genetically predisposed individuals. Imaging techniques such as OCT, OCT angiography, FA, and ICG can detect the earliest asymptomatic stages of the new vessels and minimize vision loss by appropriate use of anti-VEGF injections.

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  1. Advanced Eye Centre, Chandigarh, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Amod Gupta & Arun Kapil

  2. Advanced Eye Centre, Chandigarh, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

    Reema Bansal

  3. Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Aman Sharma

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Gupta, A., Bansal, R., Sharma, A., Kapil, A. (2023). Subretinal/Submacular Haemorrhage. In: Ophthalmic Signs in Practice of Medicine. Springer, Singapore. https://doi.org/10.1007/978-981-99-7923-3_7

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