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Tomoko Asai, Yasushi Ikuno, Kohji Nishida; Macular Microstructures and Prognostic Factors in Myopic Subretinal Hemorrhages. Invest. Ophthalmol. Vis. Sci. 2014;55(1):226-232. doi: https://doi.org/10.1167/iovs.13-12658.
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To investigate microstructural changes and visual prognosis in myopic subretinal hemorrhages (mSH) without choroidal neovascularization (CNV).
In this retrospective, observational case series, 13 consecutive eyes with mSH were followed for 6 months. The medical records, fluorescein angiography (FA), and spectral-domain optical coherence tomography (OCT) were reviewed. Fluorescein angiography confirmed the absence of CNV. The baseline and 6-month findings/parameters were investigated, including the maximal hemorrhagic height, intraretinal hyperscattering signal across the retina at 6 months (i.e., intraretinal hyperreflective sign), and integrity of the photoreceptor inner and outer segment (IS/OS) and external limiting membrane (ELM) lines.
The final visual acuity (VA) improved significantly (P = 0.001), and the hemorrhages resolved in 12 (92.3%) eyes by 6 months. The tops of the hemorrhages reached the outer nuclear layer (ONL) in three eyes (23.1%), internal limiting membrane (ILM) in five (38.5%), and between the two layers in five (38.5%). The intraretinal hyperreflective sign in all eyes extended into the ONL in five eyes (38.5%), to the ILM in four (30.8%), and between the two layers in four (30.8%). The location of the hyperreflective signs at 6 months coincided with the ruptured retinal layers at baseline in all eyes. The IS/OS line and the ELM were each intact in six (46.2%) eyes. The final VA was associated significantly with the IS/OS (P < 0.05) and ELM (P < 0.01) integrity.
The intraretinal hyperreflective sign, presumed to be scarring that enters through the disrupted outer retina, is correlated closely with photoreceptor function.
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