Radiating hemorrhage in exudative age-related macular degeneration

To investigate the characteristics of radiating hemorrhage secondary to exudative age-related macular degeneration (AMD) and its clinical significance.

This retrospective, observational case series included 288 eyes of 288 patients who initially presented with submacular hemorrhage secondary to exudative AMD. First, we estimated the incidence of radiating hemorrhage; we then compared the incidence of polypoidal choroidal vasculopathy (PCV) compared with that of the other subtypes of AMD. Optical coherence tomography (OCT) images were analyzed to identify the level of hemorrhage. The extent of submacular hemorrhage was compared between eyes with and without radiating hemorrhage.

Radiating hemorrhage was identified in 41 eyes (14.2 %). In 36 of these eyes, the OCT scanning line included the area of radiating hemorrhage. In 31 of these, OCT showed avulsion of the outer retinal layers, including the outer nuclear layer and photoreceptor layer. The outer plexiform layer and inner retinal layer were relatively well preserved. The extent of submacular hemorrhage was significantly smaller in eyes with radiating hemorrhage (mean 4.2 ± 2.9 disc areas) than in eyes without it (mean 8.3 ± 6.2 disc areas) (P < 0.001). In addition, the incidence of radiating hemorrhage was significantly higher in eyes with submacular hemorrhage secondary to PCV (19.4 %) than in those with the other subtypes of AMD (7.5 %; P = 0.025).

Radiating hemorrhage in exudative AMD was found to be a deep retinal hemorrhage generally accompanied with relatively small-sized submacular hemorrhage. The incidence of this type of hemorrhage was higher in PCV than in the other subtypes of AMD.