Predictors of 1-Year Visual Outcome in Central-Involving Submacular Hemorrhage Secondary to Neovascular AMD

To identify clinical and imaging predictors of 12-month visual outcome in patients with fovea-involving submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV).

Prospective observational clinical cohort study.

Asian patients with nAMD or PCV presenting with fovea-involving SMH.

Between January 2016 and July 2024, eyes presenting with fovea-involving SMH ≥ 1 disc diameter with no evidence of blood organization were included. All patients received standard-of-care treatment. Clinical and multimodal imaging parameters were analyzed to identify predictors of visual outcome at 12 months.

Good (≤0.3 logMAR) and poor (≥1.0 logMAR) visual outcomes at 12 months.

Among 487 treatment-naïve eyes, 75 met inclusion criteria for fovea-involving SMH. Mean (SD) age was 71.40 (9.59) years, 74.4% were male, and 76.0% had PCV. Mean hemorrhage size was 19.45 (22.65) mm². All eyes received anti-VEGF therapy, 2.6% underwent additional pneumatic displacement, and 5.3% received photodynamic therapy. Best-corrected visual acuity (BCVA) improved from 1.04 (0.67) logMAR to 0.69 (0.62) at 12 months. 25 eyes (33.3%) achieved good visual outcome, while 22 eyes (29.3%) had poor visual outcome. On multivariable analysis, younger age (OR = 0.47 per decade, 95% CI: 0.26-0.86; P = .02), better baseline BCVA (OR = 0.87 per 0.1 logMAR, 95% CI: 0.79-0.97; P < .01), and thicker subfoveal choroid (OR = 1.50 per 50 µm, 95% CI: 1.07-2.10; P = .02) independently predicted good visual outcome. Conversely, larger hemorrhage size predicted poor visual outcome (OR = 1.04 per mm², 95% CI: 1.01-1.07; P = .02).

One-third of eyes with SMH achieved 0.3 logMAR (Snellen equivalent 20/40) or better vision. In addition to age, baseline BCVA, and hemorrhage size, we identified choroidal thickness as a biomarker associated with visual outcome.