title: Identification of Underlying Causes of Spontaneous Submacular Hemorrhage by Indocyanine Green Angiography.
abstract: OBJECTIVE
  To investigate the causes of acute spontaneous submacular hemorrhage with indocyanine green angiography (ICGA).
  
  
  METHODS
  Retrospective observation case series. A total of 51 eyes from 51 patients with newly developed spontaneous submacular hemorrhage were enrolled. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography, spectral domain optical coherence tomography (OCT), and ICGA at baseline were analyzed. The extent of hemorrhage using fundus photography, height of hemorrhage, and central foveal thickness measured by OCT was analyzed to compare the diagnostic and nondiagnostic groups.
  
  
  RESULTS
  The mean logarithm of the minimum angle of resolution (logMAR) BCVA at presentation was 1.21 ± 0.74 (Snellen equivalent, 20/324); the mean follow-up period was 23.9 ± 23.9 months. The cause of submacular hemorrhage was diagnosed in 43 of 51 eyes (84.3%) based on ICGA at presentation. The initial diagnoses were correct in 93% of eyes. In 3 cases, the initial diagnosis of age-related macular degeneration (AMD) was changed to polypoidal choroidal vasculopathy (PCV) based on follow-up ICGA. The central foveal thickness was significantly greater in the nondiagnostic group (1,102.4 vs. 666.7 μm, respectively; p = 0.008). The most common cause of submacular hemorrhage was neovascular AMD (52.9%), followed by PCV (37.3%), macroaneurysm (5.9%), and lacquer crack (3.9%). The mean final visual acuity was generally worse in patients with submacular hemorrhage with typical AMD (visual acuity 20/618) or PCV (visual acuity 20/240) compared to that in patients with retinal macroaneurysm (visual acuity 20/100) or lacquer crack (visual acuity 20/72).
  
  
  CONCLUSIONS
  ICGA at initial presentation helps identify causes of submacular hemorrhage, allowing differential treatment approaches that may improve outcomes and safety.
authors.affiliation: The Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hyesun
authors.initials: H
authors.lastname: Kim
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Lee
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Kim
authors.forename: Ji Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Hyoung Jun
authors.initials: HJ
authors.lastname: Koh
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Kim
authors.forename: Suk Ho
authors.initials: SH
authors.lastname: Byeon
authors.forename: Min
authors.initials: M
authors.lastname: Kim
authors.forename: Christopher Seungkyu
authors.initials: CS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications / Q000175:diagnosis; D020256:Choroidal Neovascularization / Q000150:complications / Q000175:diagnosis; D004396:Coloring Agents / Q000737:chemistry*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green / Q000737:chemistry*; D008266:Macula Lutea; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000150:complications / Q000175:diagnosis; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D012167:Retinal Perforations / Q000150:complications / Q000175:diagnosis; D012171:Retinal Vessels / Q000473:pathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000150:complications / Q000175:diagnosis
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green