AIM:To evaluate the characterization of macular hemorrhage in pathological myopia (PM) with optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). ·METHODS:A series of retrospective cases study was designed. OCT,FFA and color photography were perform-ed on 42 patients 43 eyes of PM with macular hemorrhages. ·RESULTS:The causes and symptoms of PM with macular hemorrhage could be divided into two forms:new veins:macular hemorrhage with choroidal neovascularization (CNV) of 24 patients 24 eyes. The fundus characteristics were macular hemorrhage demonstrated oval,less than 1 disk diameter (PD),with rare edema and exudation around. And new membrana vasculosa can be seen partially. The FFA characterisitics were classic CNV of 17 eyes (71%) and occult CNV of 7 eyes (29%). The characteristics of OCT were 21 eyes (87.5%),spindle shape or circular conglomerate,strong or medium reflection,sticking out upwards from retinal pigment epithelial layers,under the epithelial layers of retinal neuroepithelial; 3 eyes (12.5%) CNV were irre-gular reflection signal which may aggregate disorder,and located on the level of retinal pigment epithelial layers. Simplex:macular hemorrhage without CNV of 18 patients 19 eyes. The fundus characteristics were flat hemorrhagic focus with different sizes and less-orderly boundary,without any exudation or edemas around. The FFA characterisitics were fluorescence blocked by hemorrh-age,without CNV high fluorescence pheno-menon. Lacquer cracks sometimes appeared at the sites of macular hemorrhage or around the hemorrhage. The characteristics of OCT were the protruded low reflection area under the retinal pigment epithelial. Choriocapillary layer with consistent photonic band. ·CONCLUSION:Most of macular hemorrhage in patho-logical myopia with new veins is caused by typical CNV. Typical figures of OCT are fusiform shape in pigment epithelium layers or quasicircular strong reflection mass,with clear boundary. Retinal protruded upwards,and choroids under it can be a shield. Simplex macular hemorrhage demonstrates as limited retinal pigment epithelial hemorrhagic detachment. OCT exami-nations were favorable for identifying the characteristics and reasons of macular hemorrhage in pathological myopia,and were helpful for diagnosis,prevention,guide and treatment.