Influence of intraretinal hemorrhage on visual outcome after the displacement of submacular hemorrhage due to ruptured retinal arterial macroaneurysm

Abstract

Purpose : In submacular hemorrhage (SMH) caused by retinal arterial macroaneurysm (RAM) rupture, it has been shown that the retinal hemorrhage can occur not only under the retina but also within the retina. Although the displacement of SMH has been reported to be effective for improving visual acuity, the influence of intraretinal hemorrhage (IRH) on postoperative visual function is unknown. In this study, we retrospectively examined the presence or absence of IRH in SMH using swept source optical coherence tomography (SS-OCT) and investigated the influence of presence of IRH on visual function after SMH displacement.

Methods : This study included 27 eyes of 27 patients with SMH associated with ruptured RAM who underwent displacement of SMH (vitrectomy + subretinal injection of tissue plasminogen activator + air tamponade) and were followed up for six months after surgery. Before the surgery, we investigated the inner structure of the SMH to assess the presence of IRH using SS-OCT. We then assessed the relationship between the existence of IRH and postoperative best-corrected visual acuity (BCVA), central retinal thickness (CRT), and continuity of the ellipsoid zone (Ez).

Results : IRH was observed in 20 eyes (IRH (+) group) and was not observed in 7 eyes (IRH (-) group). The IRH (+) group showed worse postoperative BCVA values than the IRH (-) group (0.85 ± 0.51, 0.34 ± 0.51, respectively; P < 0.05 ), thinner CRT values (76 ± 35μm, 169 ± 68μm respectively, P < 0.01 ), and a higher rate of Ez disruption (95%, 42.9%, respectively; P < 0.05).

Conclusions : Patients with preoperative IRH had poor visual acuity and retinal structure after SMH displacement compared with patients without IRH.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.