Central Bouquet Hemorrhages in Pathologic Myopia: Clinical Characteristics and Prognostic Relevance

Abstract

To compare the clinical implications of central bouquet hemorrhages (CBH) to primarily subretinal hemorrhages, both occurring in the setting of pathologic myopia with lacquer crack formation. Multi-center retrospective cohort study PARTICIPANTS: 25 eyes (11 primarily subretinal hemorrhages, 14 CBH) were monitored over a median of 35 months (interquartile range [IQR] 9.50-54). Comprehensive ophthalmological examinations and optical coherence tomography (OCT) were reviewed. The study employed linear mixed-effects models to compare the impact of CBH versus primarily subretinal hemorrhages on baseline visual acuity (VA), rate of VA improvement, and final VA, adjusting for the follow-up period. Times of hemorrhages reabsorbtion and rate of ellipsoid zone (EZ) layer disruption on OCT were recorded. Eyes with CBH exhibited significantly worse baseline VA (0.93±0.45[20/160 Snellen] vs. 0.36±0.26[20/50 Snellen] LogMAR, p<0.001), a slower rate of VA improvement (p=0.04), and a trend towards worse final VA (0.48±0.47[20/60 Snellen] vs. 0.16±0.16[20/30 Snellen] LogMAR, p=0.06) compared to eyes with primarily subretinal hemorrhages. The CBH group experienced prolonged reabsorption times (median 10 months [IQR 4.6-23.3] vs. 2.3 months [IQR 2-3.2]) and a high prevalence of EZ layer disruption (86% vs. 0%) than primarily subretinal hemorrhages. CBH reabsorption was followed by the appearance of vertical hyperreflective lines in the central fovea in 67% of eyes, persisting for up to 6 years of follow-up. CBH signifies a distinct condition in pathologic myopia, characterized by worse visual outcomes, prolonged structural impact, and possible irreversible damage, compared to primarily subretinal hemorrhages. CBH regression should be taken into account in the differential diagnosis of vertical hyperreflective lesions in the central fovea on OCT in eyes with pathologic myopia.