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‘Structural OCT changes distinguishing between myopic macular haemorrhages due to choroidal neovascularization and spontaneous Bruch’s membrane rupture: the “myopic 2 binary reflective sign”

Eye volume 38, pages 792–797 (2024)Cite this article

Subjects

Abstract

Objective

To evaluate the sensitivity and specificity of structural optical coherence tomography (OCT) in comparison to fluorescein angiography (FA) and OCT angiography (OCTA) in discerning between macular haemorrhages (MH) due to myopic choroidal neovascularization (m-CNV) and idiopathic macular haemorrhage (IMH) in myopic patients and to suggest a new OCT biomarker to discern these two entities.

Methods and analysis

In this longitudinal retrospective study, patients affected by MH and pathological myopia were included. All patients underwent OCTA and FA to discern bleeding from m-CNV or IMH. Furthermore, all patients underwent a structural OCT and 2 expert graders evaluated the presence of the myopic 2 binary reflective sign as a biomarker to discern between IMH and bleeding from m-CNV.

Results

Forty-seven eyes of 47 patients were enrolled. By means of angiographic examinations, 34 out of 47 eyes with MH (57%) were diagnosed as m-CNV, whereas 13 eyes (43%) as IMH. Using structural OCT, the graders identified the presence of the myopic 2 binary reflective sign in 13 out of 13 eyes with IMH. In 33 out of 34 cases with m-CNV, the 2 graders established the absence of the sign. This accounted for 100% of sensibility and 97% of specificity of structural OCT in discerning between MH from m-CNV and IMH.

Conclusion

Structural OCT can discern with good reliability between IMH and bleeding from m-CNV based on the presence/ absence of the myopic 2 binary reflective sign. This could be of paramount relevance in the clinical setting for the diagnosis and treatment of HM patients.

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Fig. 1: Myopic 2 binary reflective sign of a patient with idiopathic macular haemorrhage (IMH) in the left eye.
Fig. 2: Multimodal retinal imaging of a patient with idiopathic macular haemorrhage (IMH) in the left eye.
Fig. 3: Multimodal retinal imaging of a patient with macular haemorrhage due to type 2 choroidal neovascularization (CNV) in the left eye.
Fig. 4: Multimodal retinal imaging of doubtful cases regarding presence/absence of the “myopic 2 binary reflective sign”.

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Data availability

The datasets generated and/or analysed during the current study, which were used for all statistical analyses and for the creation of all figures, as well as the Table 1, are available from the corresponding author upon reasonable request.

References

  1. Ruiz-Medrano J, Montero JA, Flores-Moreno I, Arias L, García-Layana A, Ruiz-Moreno JM. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN). Prog Retin Eye Res. 2019;69:80–115. https://doi.org/10.1016/J.PRETEYERES.2018.10.005

    Article  PubMed  Google Scholar 

  2. Corbelli E, Parravano M, Sacconi R, Sarraf D, Yu SY, Kim K, et al. Prevalence and phenotypes of age-related macular degeneration in eyes with high myopia. Invest Ophthalmol Vis Sci. 2019;60:1394–402. https://doi.org/10.1167/IOVS.18-25534

    Article  CAS  PubMed  Google Scholar 

  3. Neelam K, Cheung CMG, Ohno-Matsui K, Lai TYY, Wong TY. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res. 2012;31:495–525. https://doi.org/10.1016/J.PRETEYERES.2012.04.001

    Article  CAS  PubMed  Google Scholar 

  4. Kumar A, Chawla R, Kumawat D, Pillay G. Insight into high myopia and the macula. Indian J Ophthalmol. 2017;65:85–91. https://doi.org/10.4103/IJO.IJO_863_16

    Article  PubMed Central  PubMed  Google Scholar 

  5. Ohno-Matsui K, Ikuno Y, Lai TYY, Gemmy Cheung CM. Diagnosis and treatment guideline for myopic choroidal neovascularization due to pathologic myopia. Prog Retin Eye Res. 2018;63:92–106. https://doi.org/10.1016/J.PRETEYERES.2017.10.005

    Article  PubMed  Google Scholar 

  6. Ohno-Matsui K, Yoshida T, Futagami S, Yasuzumi K, Shimada N, Kojima A, et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia. Br J Ophthalmol. 2003;87:570–3. https://doi.org/10.1136/BJO.87.5.570

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Hayashi K, Ohno-Matsui K, Shimada N, Moriyama M, Kojima A, Hayashi W, et al. Long-term pattern of progression of myopic maculopathy: a natural history study. Ophthalmology (2010);117. https://doi.org/10.1016/J.OPHTHA.2009.11.003

  8. Wong TY, Ohno-Matsui K, Leveziel N, Holz FG, Lai TY, Yu HG, et al. Myopic choroidal neovascularisation: current concepts and update on clinical management. Br J Ophthalmol. 2015;99:289–96. https://doi.org/10.1136/BJOPHTHALMOL-2014-305131

    Article  PubMed  Google Scholar 

  9. Borrelli E, Battista M, Vella G, Sacconi R, Querques L, Grosso D, et al. Three-year OCT predictive factors of disease recurrence in eyes with successfully treated myopic choroidal neovascularisation. Br J Ophthalmol. 2022;106:1132–8. https://doi.org/10.1136/BJOPHTHALMOL-2020-318440

    Article  PubMed  Google Scholar 

  10. Parodi MB, Iacono P, Sacconi R, Iuliano L, Bandello F. Fundus autofluorescence changes after ranibizumab treatment for subfoveal choroidal neovascularization secondary to pathologic myopia. Am J Ophthalmol. 2015;160:322–27.e2. https://doi.org/10.1016/J.AJO.2015.04.030

    Article  CAS  PubMed  Google Scholar 

  11. Querques G, Corvi F, Balaratnasingam C, Casalino G, Parodi MB, Introini U, et al. Lacquer cracks and perforating scleral vessels in pathologic myopia: a possible causal relationship. Am J Ophthalmol. 2015;160:759–66.e2. https://doi.org/10.1016/J.AJO.2015.07.017

    Article  PubMed  Google Scholar 

  12. Ohno-Matsui K, Ito M, Tokoro T. Subretinal bleeding without choroidal neovascularization in pathologic myopia. A sign of new lacquer crack formation. Retina. 1996;16:196–202. https://doi.org/10.1097/00006982-199616030-00003

    Article  CAS  PubMed  Google Scholar 

  13. Ren P, Lu L, Tang X, Lu H, Zhao Y, Lou D, et al. Clinical features of simple hemorrhage and myopic choroidal neovascularization associated with lacquer cracks in pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 2020;258:2661–9. https://doi.org/10.1007/S00417-020-04778-6

    Article  PubMed  Google Scholar 

  14. Curtin BJ. Pathologic myopia. Acta Ophthalmol Suppl (Oxf). 1988;185:105–6. https://doi.org/10.1111/J.1755-3768.1988.TB02680.X

    Article  CAS  Google Scholar 

  15. Battista M, Sacconi R, Borrelli E, Crepaldi A, Fantaguzzi F, Costanzo E, et al. Discerning between macular hemorrhages due to macular neovascularization or due to spontaneous bruch’s membrane rupture in high myopia: a comparative analysis between OCTA and fluorescein angiography. Ophthalmol Ther. 2022;11:821–31. https://doi.org/10.1007/S40123-022-00484-0

    Article  PubMed Central  PubMed  Google Scholar 

  16. Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Prog Retin Eye Res. 2018;64:1–55. https://doi.org/10.1016/j.preteyeres.2017.11.003

    Article  PubMed  Google Scholar 

  17. Senn S. Review of Fleiss, statistical methods for rates and proportions. Res Synth Methods. 2011;2:221–2. https://doi.org/10.1002/JRSM.50

    Article  PubMed  Google Scholar 

  18. Ohno-Matsui K, Lai TYY, Lai CC, Cheung CMG. Updates of pathologic myopia. Prog Retin Eye Res. 2016;52:156–87. https://doi.org/10.1016/J.PRETEYERES.2015.12.001

    Article  PubMed  Google Scholar 

  19. Yannuzzi LA, Rohrer KT, Tindel LJ, Sobel RS, Costanza MA, Shields et al. Fluorescein angiography complication survey. Ophthalmology. 1986;93:611–7. https://doi.org/10.1016/s0161-6420(86)33697-2

  20. Laíns I, Wang JC, Cui Y, Katz R, Vingopoulos F, Staurenghi G, et al. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Prog Retin Eye Res (2021);84. https://doi.org/10.1016/J.PRETEYERES.2021.100951

  21. Sacconi R, Forte P, Tombolini B, Grosso D, Fantaguzzi F, Pina A, et al. OCT predictors of 3-year visual outcome for Type 3 macular neovascularization. Ophthalmol Retin. 2022;6:586–94. https://doi.org/10.1016/J.ORET.2022.02.010

    Article  Google Scholar 

  22. Marchese A, Carnevali A, Sacconi R, Centoducati T, Querques L, Bandello F, et al. Retinal pigment epithelium humps in high myopia. Am J Ophthalmol. 2017;182:56–61. https://doi.org/10.1016/J.AJO.2017.07.013

    Article  PubMed  Google Scholar 

  23. Asai T, Ikuno Y, Nishida K. Macular microstructures and prognostic factors in myopic subretinal hemorrhages. Invest Ophthalmol Vis Sci. 2014;55:226–32. https://doi.org/10.1167/IOVS.13-12658

    Article  PubMed  Google Scholar 

  24. Querques L, Giuffrè C, Corvi F, Zucchiatti I, Carnevali A, de Vitis LA, et al. Optical coherence tomography angiography of myopic choroidal neovascularisation. Br J Ophthalmol. 2017;101:609–15. https://doi.org/10.1136/BJOPHTHALMOL-2016-309162

    Article  PubMed  Google Scholar 

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Author notes

  1. These authors contributed equally: Cecilia Mularoni, Andrea Servillo.

Authors and Affiliations

  1. Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    Cecilia Mularoni, Andrea Servillo, Riccardo Sacconi, Marco Battista, Emanuele Crincoli, Anna Crepaldi, Lea Querques, Francesco Bandello & Giuseppe Querques

  2. School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy

    Cecilia Mularoni, Andrea Servillo, Riccardo Sacconi, Marco Battista, Emanuele Crincoli, Anna Crepaldi, Lea Querques, Francesco Bandello & Giuseppe Querques

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Contributions

Conception or design of the work: GQ, FB, RS, MB. Acquisition, analysis, or interpretation of data: RS, MB, CM, AS, AC. Drafted the work or substantively revised it: GQ, FB, RS, LQ, EC, CM, AS, MB, AC.

Corresponding author

Correspondence to Giuseppe Querques.

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Competing interests

RS is consultant for Allergan Inc, Bayer Shering-Pharma, Medivis, Novartis, and Zeiss. FB is consultant for Alcon, Alimera Sciences, Allergan Inc, Farmila-Thea, Bayer Shering-Pharma, Baush and Lomb, Genentech, Hoffmann-La-Roche, Novagali Pharma, Novartis, Sanofi-Aventis, Thrombogenics, and Zeiss. GQ is consultant for Alimera Sciences, Allergan Inc, Amgen, Bayer Shering-Pharma, Heidelberg, KBH, LEH Pharma, Lumithera, Novartis, Sandoz, Sifi, Sooft-Fidea, and Zeiss. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Mularoni, C., Servillo, A., Sacconi, R. et al. ‘Structural OCT changes distinguishing between myopic macular haemorrhages due to choroidal neovascularization and spontaneous Bruch’s membrane rupture: the “myopic 2 binary reflective sign”. Eye 38, 792–797 (2024). https://doi.org/10.1038/s41433-023-02780-w

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