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To the Editor.—
A misstatement occurs in the second paragraph in which the authors state that disciform degeneration of the macula is due to a change in localized capillary fragility. There is no evidence that this is so. The changes that precede bleeding in the macular region are related to disease of the pigment epithelium and Bruch's membrane, and these may exist for long periods without capillary involvement. Eventually, calcification of the elastic tissue in Bruch's membrane, or changes in the collagen may lead to secondary proliferation of capillaries from the choroidal vessels. There is good evidence from fluorescein angiography that new vessels may be present in serous disciform lesions and senile macular degenerations for long periods without bleeding. Bleeding may be initiated by effort or by rubbing the eyes.We have seen patients who were treated with anticoagulants in the presence of formation of new vessels in the macular
Hogan MJ. Systemic Anticoagulation And Intraocular Hemorrhage. JAMA. 1972;221(13):1516. doi:10.1001/jama.1972.03200260052021