Poller S, Hesse L
Medizinisches Zentrum für Augenheilkunde, Philipps-Universität, Marburg.
Klin Monbl Augenheilkd. 1997 Jun;210(6):384-7. doi: 10.1055/s-2008-1035079.
Hemorrhages from subretinal neovascularizations in age-related macular degeneration are not uncommon, but usually limited to the posterior pole. A therapy-resistant angle closure glaucoma following displacement of the lens-iris diaphragm due to massive choroidal and subretinal hemorrhages has rarely been reported.
A 72-year-old female patient was first seen in September 1993 because of decreased vision in the right eye. An age related macular degeneration with an extended untreatable neovascularisation membrane was diagnosed. One year later sudden pain attacks were initiated by secondary angle closure glaucoma, caused by a massive choroidal and subretinal bleeding. At first the IOP could be regulated by drug therapy, however, recurring hemorrhages led to continuously elevated IOP. The reason for the recurrent massive hemorrhages was found to be a disorder of the platelet function. Since the IOP (50-80 mm Hg) could not be controlled any further, we decided to perform a sclerotomy in an attempt to drain the blood. Within one day another bleeding occurred and again led to an increase in IOP. Finally, the patient agreed to have the eye enucleated.
In case of massive hemorrhages in age related macular degeneration a haematological systemic disorder must be included in the diagnostic considerations. If the intraocular pressure can not be lowered neither medically nor surgically, enucleation can not be avoided.
年龄相关性黄斑变性引起的视网膜下新生血管出血并不少见，但通常局限于后极部。因大量脉络膜和视网膜下出血导致晶状体虹膜隔移位后出现难治性闭角型青光眼的情况鲜有报道。
一名72岁女性患者于1993年9月初诊，因右眼视力下降。诊断为年龄相关性黄斑变性伴广泛不可治疗的新生血管膜。一年后，继发于大量脉络膜和视网膜下出血的继发性闭角型青光眼引发突然疼痛发作。起初，眼压可通过药物治疗控制，但反复出血导致眼压持续升高。发现反复大量出血的原因是血小板功能障碍。由于眼压（50 - 80 mmHg）无法进一步控制，我们决定进行巩膜切开术试图引流血液。一天内又发生一次出血，再次导致眼压升高。最后，患者同意摘除眼球。
在年龄相关性黄斑变性出现大量出血的情况下，诊断时必须考虑血液系统全身性疾病。如果眼压无法通过药物或手术降低，摘除眼球不可避免。
