Visual Prognosis of Eyes with Subretinal hemorrhage Associated with Age-related Macular Degeneration

Abstract

Purpose: : To study the retinal structural changes associated with subretinal hemorrhage from age-related macular degeneration (AMD) and the association with the visual prognosis.

Methods: : We reviewed retrospectively medical records of 34 consecutive patients (34 eyes) with visual impairment due to acute thick subretinal hemorrhage associated with AMD. Of these 34 eyes, 23 had polypoidal choroidal vasculopathy, and 11 had typical AMD. At the initial visit, the retinal structural changes were examined by spectral-domain optical coherence tomography (OCT).

Results: : On the initial OCT, subretinal hemorrhage showed intensive or middle hyperreflectivity beneath the neurosensory retina, depending on the density of the subretinal hemorrhage. Furthermore, subretinal hemorrhage often seemed to sink into the overlying neurosensory retina. On OCT sections, mild to moderate amorphous hyperreflectivity and/or hyperreflective dots were seen within the overlying neurosensory retina, especially in the outer aspect, resulting in the lack of the inner and outer segments of the photoreceptors (IS/OS) or external limiting membrane (ELM). Of 34 eyes, an IS/OS line could not be seen completely in 31 eyes and an ELM line could not be seen completely in 11 eyes. We studied the associations of final visual acuity (VA) with other measurement values obtained at the initial examination. Type of diseases has no significant correlations with final VA (R = 0.33, P = 0.058). The size of the subretinal hemorrhage showed no correlation with final VA (R = 0.04, P = 0.083). However, the integrity of the foveal photoreceptor layer has a correlation with the final VA; the initial detection of IS/OS just beneath the fovea showed a correlation with good final VA (R = -0.37, P = 0.031).

Conclusions: : Subretinal hemorrhage associated with AMD tends to sink into the overlying neurosensory retina and make harmful effects on the structure of the neurosensory retina, especially on outer retina. As a hallmark of the integrity of the foveal photoreceptor layer, initial detection of IS/OS just beneath the fovea may predict good visual prognosis.

Keywords: age-related macular degeneration