Massive spontaneous subretinal hemorrhage.

We studied eight cases of massive, spontaneous subretinal hemorrhage which was characterized by the sudden appearance of one or more large, dark, elevated hematomas under the retina. The initial location of the hemorrhage may have been in the choroid or under the pigment epithelium, or both, but further extravasation of the blood anteriorly frequently resulted in hemorrhage under the neurosensory retina and in the vitreous. Although the lesion can initially be mistaken for a melanoma, the diagnosis is confirmed by the formation of a typical, elevated scar in the involved area. Frequent fundus examinations are essential, and ultrasound, radioactive phosphorus uptake testing, and bilateral patching are helpful in establishing the diagnosis. The hemorrhage is usually the result of a ruptured vessel from a subretinal neovascular network or arterioclerotic degeneration and may be precipitated by the use of anticoagulants.