Maurice F. Rabb » Small Macular Hemorrhage

A 56 year old lady was referred because of a small macular hemorrhage and lipid in the left eye. She was asymptomatic.

In each eye, the acuity was 20/20, the media were clear, and there were multiple large confluent drusen in the macula.

The fluorescein angiogram showed early and late hyperfluorescence corresponding to the macular drusen. In the left macula, an area of hyperfluorescence adjacent to the hemorrhage and lipid was interpreted as probable choroidal neovascularization (CNV). This CNV was so subtle that it almost certainly would not have been detected were it not for the hemorrhage and lipid.

The area of CNV was treated with two spots of argon green photocoagulation. Examinations over the next seven months showed no evidence of leakage. The patient has maintained 20/20 in each eye although there is a scotoma OS corresponding to the area of laser treatment.

There are two points of interest in this case. The first is that the CNV represents the smallest ever seen by the author. The second is that the drusen in the left macula have virtually disappeared since the laser treatment.

The initial photographs and angiograms show nearly symmetric confluent drusen in the two eyes. Two months after treatment, January, 1993, the drusen in the superior half of the left macula appear less extensive. In March, 1993, four months after treatment, the asymmetry was even more dramatic. By June, 1993, seven months after treatment, the majority of drusen in the left macula were not visible ophthalmoscopically or angiographically. At the FA Club meeting, I plan to show photographs and angiograms from November, 1993 which will represent a one year follow-up.