Br J Ophthalmol 95:1051-1057 doi:10.1136/bjo.2010.182253
  • Review

Submacular haemorrhages associated with neovascular age-related macular degeneration

  1. Sukhpal Singh Sandhu1,2
  1. 1Sunderland Eye Infirmary, Sunderland, UK
  2. 2Centre for Eye Research Australia, Melbourne, Australia
  1. Correspondence to Mr David H W Steel, Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland SR2 9HP, UK; david.steel{at}
  • Accepted 18 July 2010
  • Published Online First 2 September 2010


The exact incidence of submacular haemorrhage (SMH) in patients with neovascular age-related macular degeneration (nAMD) is unknown, and risk factors for its occurrence ill defined. It is known, however, to be a relatively common problem and important because the visual prognosis of these patients is poor. Unfortunately, patients with significant SMH were excluded from all the recent major randomised control trials for nAMD with antivascular endothelial growth factor (VEGF) agents and photodynamic therapy, and as such, the optimum management of patients is uncertain. SMH can present initially or during treatment of nAMD. The location, size, thickness and duration of SMH have an important bearing on treatment and outcomes. Thin or extrafoveal SMH are probably best treated with anti-VEGF agents alone. It has been proposed that patients with moderate-sized SMH, particularly thick haemorrhages, have an improved prognosis with surgical SMH displacement combined with treatment of CNVM if present. SMH drainage, macular translocation and RPE patch grafting are reserved for more severe extensive cases of SMH. Using these techniques, outcomes better than the natural history have been achieved. This review aims to summarise what is known about SMH in nAMD and will discuss a variety of therapeutic interventions.


  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.

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