Visual prognosis of eyes with submacular hemorrhage associated with exudative age-related macular degeneration

[Purpose]To study the retinal structural changes associated with submacular hemorrhage due to exudative age-related macular degeneration (AMD) and their relationships with visual prognosis. [Methods]We retrospectively reviewed the medical records of 31 consecutive patients (31 eyes) with visual impairment due to an acute submacular hemorrhage associated with typical AMD (10 eyes) or polypoidal choroidal vasculopathy (21 eyes). [Results]Optical coherence tomography (OCT) revealed that submacular hemorrhage exhibited intense hyperreflectivity beneath the neurosensory retina and often seemed to infiltrate it. In the OCT sections, mild to moderate amorphous hyperreflectivity and/or hyperreflective dots were observed within the neurosensory retina, resulting in the loss of the junctions between the inner (IS) and outer (OS) segments of the photoreceptors. Of the 31 eyes, the foveal IS/OS line could be seen incompletely in 12 eyes and was totally absent in 16 eyes. The initial integrity of the foveal photoreceptor layer was correlated with the final visual acuity; the initial detection of the IS/OS just beneath the fovea was correlated with good final visual acuity (r = 0.375, p = 0.038). [Conclusion]As a hallmark of integrity of the foveal photoreceptor layer, the initial detection of the IS/OS just beneath the fovea may predict good visual outcomes.