AIM:To observe the imaging features of optical coherence tomography angiography(OCTA)in the macular hemorrhage of pathologic myopia.

METHODS:Designing a retrospective analysis collected clinical data of 100 patients(108 eyes)diagnosed as macular hemorrhage of pathological myopic in Nanjing Medical University Affiliated Eye Hospital from June 2016 to December 2020. All patients underwent refraction, eye axis,fundus photography, spectral-domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and OCTA examination. All patients were divided into macular hemorrhage only with lacquer cracks and macular hemorrhage with choroidal neovascularization(CNV). All patients followed-up for more than 3mo by OCTA.

RESULTS:There were 40 patients(42 eyes)diagnosed as macular hemorrhage only with lacquer cracks, OCTA showed bleed obscured by choroidal capillaries. After hemorrhage was being absorbed, lacquer cracks showed linear or stellate reflection completely in the choroidal capillary layer. B-scan image showed discontinuous retinal pigment epithelium(RPE), thinner choroid and an increased light. Penetrance into deeper tissues. After all macular hemorrhage only with lacquer cracks were absorbed, follow-up mode of OCTA found that 2 eyes(4.8%)without lacquer cracks, 28 eyes(66.7%)were linear and 12 eyes(28.6%)were stellate under the original hemorrhage. Follow-up mode also showed that 8 eyes of 8 patients(19.0%)relapsed macular hemorrhage only with lacquer cracks, and 4 eyes of 4 patients(9.5%)suffered secondary macular hemorrhage with CNV. There were 60 patients(66 eyes)diagnosed as macular hemorrhage with CNV,OCTA showed bleed obscured choroidal capillaries, the outer retinal and choroidal capillary layer also showed the shape of CNV around hemorrhage. B-scan showed CNV breaked through the RPE layer and blood flow signal in it. The area of CNV decreased after anti-vascular endothelial growth factor(VEGF)intravitreal injection treatment. Around all macular hemorrhage with CNV, OCTA found that 48 eyes(72.7%)had lacquer cracks, 28 eyes(42.4%)were linear and 20 eyes(30.3%)were stellate.

CONCLUSION:OCTA has a great significance in the diagnosis of macular hemorrhage of pathological myopia, fast and non-invasive is the biggest advantage. Choroidal capillary layer can clearly observe the shape and location of hemorrhage,lacquer cracks and CNV. The follow-up mode can intuitively comprehend the changes of disease. To some extent, it can replace fundus angiography to directly judge the classification, and time to treat in the clinic.