Visual Outcome After Submacular Hemorrhage Dependent on Disease Subtype

Age Related Macular Degeneration, Also Called Senile Macular Degeneration. Choroidal Neovascularization. Photograph Of The Back Of Eye. (Photo By BSIP/UIG Via Getty Images)
Researchers show differences in outcomes between patient groups following treatment.

When clinicians search for new insights on the elements affecting visual outcome after treatment for submacular hemorrhage, they may find that few papers have analyzed the impact age-related macular degeneration (AMD) subtype has on prognosis, say researchers who have recently evaluated acuity results following treatment with pneumatic displacement.

In fact, investigators conducting the retrospective review found distinct and significant differences in best corrected visual acuity (BCVA) by AMD subtype, and time to treatment. “Logistic regression analysis showed that AMD subtype (P =.016) and time to treatment (<7 days) (P =.037) are associated with the final visual outcome,” according to the study.

Study participants comprised 67 eyes of 67 patients with submacular hemorrhage who received care  between January 2017 and December 2018. They were treated with pneumatic displacement combined with a tissue plasminogen activator, as well as an anti-vascular endothelial growth factor (VEGF) injection within the following week. Patients then received further monthly intravitreal injections or pars plana vitrectomy as required. Mean follow-up was approximately 13.05 months. Of the 67 eyes, 24 were identified as part of the typical AMD group, 30 in the polypoidal choroidal vasculopathy (PCV) set, and 13 as members of the retinal angiomatous proliferation (RAP) subtype.

Before treatment, participants with PCV presented with better visual acuity than those in the AMD group, and subjects with AMD displayed better acuity than participants in the RAP group. After treatment, more substantial differences in acuity appeared that were dependent on nAMD subtype, when researchers adjusted for BCVA at time of hemorrhage and subject’s age — better acuity in subjects with PCV, and worse for those with RAP, (P <.001), according to the review. “Polypoidal choroidal vasculopathy, which is known to show benign progress, seems to be associated with better visual outcome even after the incidence of submacular hemorrhage,” the investigators explained.

Participants with RAP experienced poorer visual outcome post-treatment than either typical AMD or PCV, as demonstrated in the following logMAR BCVA scores:

  • At hemorrhage, BCVA for subjects with typical AMD measured 1.25 ± 0.59, with final acuity of 1.11 ±6.52
  • At hemorrhage, BCVA for those with PCV was evaluated at 1.02 ± 0.57, with final acuity at 0.65 ± 0.58
  • At hemorrhage, BCVA for participants with RAP was 1.67 ±0.45, with final acuity at 1.53 ± 0.63

Further analysis demonstrated that patients older than 75 years exhibited post-treatment differences in BCVA — although not statistically significant — based on their AMD subtype (P =.092). However, regarding visual outcome for participants younger than 75, those with PCV fared significantly better than subjects in the typical AMD and RAP groups (P =.003).

Limitations of this study included the possibility of selection bias based on its retrospective and nonrandomized nature, and a small sample size. 


Lee K, Park Y, Park Y., Visual prognosis after pneumatic displacement of submacular hemorrhage according to age-related macular degeneration subtypes. Retina. 2020;40(12):2304-2311. doi:10.1097/IAE.0000000000002762.