Submacular Hemorrhage: Visual Outcomes and Prognostic Factors

Abstract

Purpose: To describe causes, visual outcomes, and prognostic factors in patients with submacular hemorrhage (SMH).

Design: Retrospective case review.

Methods: We performed a retrospective review of SMH with a size of at least 1 disc diameter. SMH causes were classified into 3 groups: 1) neovascular age-related macular degeneration (nAMD), 2) polypoidal choroidal vasculopathy (PCV), and 3) other miscellaneous causes.

Results: Ninety-eight eyes of 98 patients were included. Based on clinical presentation and indocyanine green angiography (ICGA), the diagnoses of PCV (59%), nAMD (31%), and miscellaneous other causes (10%) were made. PCV patients were younger (P = 0.005) and had larger SMH size than nAMD patients (P = 0.008). Poor visual outcome [>1.0 logarithm of the minimum angle of resolution (logMAR)] at 6 months was associated with low initial visual acuity (VA; >1.0 logMAR; P = 0.002) and with the diagnosis of nAMD (P = 0.02). In addition, limited visual outcomes were noted for patients older than 65 years and those with persistent SMH for at least 2 months.

Conclusions: PCV was the most common cause of SMH in Thailand. ICGA represented a valuable tool for the diagnosis. Visual outcomes were limited for patients with nAMD and for patients who presented with poor initial VA.

Keywords: indocyanine green angiography; neovascular age-related macular degeneration; polypoidal choriodal vasculopathy; submacular hemorrhage; visual outcomes.