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Identification of Underlying Causes of Spontaneous Submacular Hemorrhage by Indocyanine Green Angiography

Authors
 Kim H ; Lee SC ; Lee CS ; Kim M ; Byeon SH ; Kim SS ; Koh HJ ; Lee JH ; Kim SM 
Citation
 Ophthalmologica, Vol.233(3-4) : 146~154, 2015 
Journal Title
 Ophthalmologica 
ISSN
 0030-3755 
Issue Date
2015
Abstract
PURPOSE: To investigate the causes of acute spontaneous submacular hemorrhage with indocyanine green angiography (ICGA). METHODS: Retrospective observation case series. A total of 51 eyes from 51 patients with newly developed spontaneous submacular hemorrhage were enrolled. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography, spectral domain optical coherence tomography (OCT), and ICGA at baseline were analyzed. The extent of hemorrhage using fundus photography, height of hemorrhage, and central foveal thickness measured by OCT was analyzed to compare the diagnostic and nondiagnostic groups. RESULTS: The mean logarithm of the minimum angle of resolution (logMAR) BCVA at presentation was 1.21 ± 0.74 (Snellen equivalent, 20/324); the mean follow-up period was 23.9 ± 23.9 months. The cause of submacular hemorrhage was diagnosed in 43 of 51 eyes (84.3%) based on ICGA at presentation. The initial diagnoses were correct in 93% of eyes. In 3 cases, the initial diagnosis of age-related macular degeneration (AMD) was changed to polypoidal choroidal vasculopathy (PCV) based on follow-up ICGA. The central foveal thickness was significantly greater in the nondiagnostic group (1,102.4 vs. 666.7 μm, respectively; p = 0.008). The most common cause of submacular hemorrhage was neovascular AMD (52.9%), followed by PCV (37.3%), macroaneurysm (5.9%), and lacquer crack (3.9%). The mean final visual acuity was generally worse in patients with submacular hemorrhage with typical AMD (visual acuity 20/618) or PCV (visual acuity 20/240) compared to that in patients with retinal macroaneurysm (visual acuity 20/100) or lacquer crack (visual acuity 20/72). CONCLUSIONS: ICGA at initial presentation helps identify causes of submacular hemorrhage, allowing differential treatment approaches that may improve outcomes and safety.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/140559
DOI
10.1159/000380830
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Ophthalmology
Yonsei Authors
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Link
 http://www.karger.com/Article/FullText/380830
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