Discerning between macular hemorrhages due to macular neovascularization or due to spontaneous Bruch’s membrane rupture in high myopia: A comparative analysis between OCTA and fluorescein angiography

Author: Anna Crepaldi (Italy)

Co-authors: Riccardo Sacconi, Marco Battista, Enrico Borrelli, Mariacristina Parravano, Francesco Bandello, Giuseppe Querques

Purpose

To evaluate the sensitivity and specificity of optical coherence tomography angiography (OCTA) in comparison to fluorescein angiography (FA) in discerning between macular hemorrhages due to myopic macular neovascularization (m-MNV) and idiopathic macular hemorrhage (IMH) in high myopic (HM) patients.

Setting/Venue

All patients were identified from the medical records of the Medical Retina and Imaging Unit at the San Raffaele Scientific Institute, Milan, Italy.

Methods

In this longitudinal study, 13 eyes of 13 patients (mean age 60±17 years) affected by macular hemorrhage due to HM were included. All patients underwent OCTA and FA at the time of macular hemorrhage (i.e. baseline) and were followed for a 3-month follow-up. The main outcome measure included the sensitivity and specificity of OCTA in discerning between m-MNV and IMH.

Results

By means of FA, 7 out of 13 eyes with macular hemorrhage (54%) were diagnosed as type 2 m-MNV, whereas 6 eyes (46%) as IMH. Interestingly, OCTA displayed the presence of a neovascular network in all cases previously diagnosed as m-MNV using FA, and also excluded the presence of anomalous flow in all IMH eyes. This accounted for 100% of the sensibility and specificity of OCTA for m-MNV detection in HM cases with macular hemorrhage. After 3-month follow-up, BCVA improved from 0.39±0.16 to 0.21±0.15 LogMAR (p=0.017) in patients with m-MNV treated by a mean of 2.4±0.8 intravitreal anti-VEGF injections. Conversely, BCVA improved without treatment (from 0.55±0.48 to 0.17±0.08 LogMAR, p=0.112) in IMH patients.

Conlusions

OCTA is able to discern with excellent reliability between the presence of m-MNV in HM patients presenting with a new macular hemorrhage and a IMH. This could be of paramount relevance in the clinical setting for the diagnosis and treatment of HM patients.

Financial Disclosure

none