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

Introduction 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 patients with high myopia (HM). Methods In this retrospective study, 14 eyes of 14 patients (mean age 60 +/- 16 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. Results By means of FA, 8 out of 14 eyes with macular hemorrhage (57%) were diagnosed as type 2 m-MNV, whereas 6 eyes (43%) were diagnosed 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 the high sensitivity and specificity of OCTA for m-MNV detection in HM cases with macular hemorrhage. After 3-month follow-up, BCVA improved from 0.39 +/- 0.15 to 0.21 +/- 0.14 logMAR (p = 0.006) in patients with m-MNV treated by a mean of 2.3 +/- 0.9 intravitreal anti-VEGF injections. Conversely, BCVA improved without treatment (from 0.55 +/- 0.48 to 0.17 +/- 0.08 logMAR, p = 0.112) in patients with IMH. Conclusions OCTA is able to differentiate with excellent reliability between the presence of m-MNV in patients with HM presenting with a new macular hemorrhage and an IMH. This could be of paramount relevance in the clinical setting for the diagnosis and treatment of patients with HM.