Relationship between anticoagulant medication and massive intraocular hemorrhage in age-related macular degeneration

BACKGROUND

A massive intraocular hemorrhage in the course of age-related macular degeneration (AMD) is a devastating event. We set out to determine the role of anticoagulant therapy prescribed for vascular or cardiac indications in the development of a massive hemorrhage.

METHODS

A retrospective case-controlled study was conducted of 50 cases of age-related macular degeneration complicated by massive subretinal and vitreous hemorrhage. The control group consisted of 50 cases of AMD with small subretinal hemorrhage.

RESULTS

There was a significant difference in the use of anticoagulant medication (warfarin sodium) between the groups. The difference in the use of antiplatelet medication (aspirin) between the groups was not significant. A patient with a massive intraocular hemorrhage and AMD is 11.6 times more likely to use anticoagulant medication. It appeared that more than 50% of the patients in the massive hemorrhage group were allowed to stop the anticoagulant medication.

CONCLUSION

Anticoagulant medication poses a significant risk in the development of a massive intraocular hemorrhage in patients with exudative AMD. Antiplatelet medication poses a less significant risk. Physicians prescribing anticoagulant medication should be informed about the macular status of the patient. the In case of neovascular AMD, anticoagulant medication should be prescribed only for absolute systemic indications.

[Acanthamoeba keratitis]

Three patients, women aged 69, 25 and 30 years, with refractory keratitis were found to have a rare infection with Acanthamoeba. All wore soft contact lenses. The frequency of Acanthamoeba keratitis increased in recent years. At present, an efficacious antiprotozoal therapy is available, for instance in the form of polyhexamethylene biguanide and propamidine. In cases of refractory keratitis, the possibility of an Acanthamoeba infection should be taken into account.

[Obese children and their treatment]

Retrospectively the data were analyzed of 188 children treated for obesity. The mean age at which obesity begins is 5,5 years, but the mean age at which medical help is sought is 9,5 years. In 78% of these children one or both parents were obese. The mean caloric value of the pretreatment feeding pattern was 924 kJ (220 kCal) less than the reference quantities for age. Thirty-nine percent of cases stopped visiting the clinic themselves. Mean weight loss is 10% of the median weight-for-height. No differences were found between the results of various therapeutical regimens.