I read with great interest the article by Ikuno entitled “Overview of the Complications of High Myopia.”1 In this narrative review, the author provides to the readers an overview of the complications of degenerative myopia, including cataract formation, retinal detachment from peripheral retinal tears, myopic foveoschisis, macular hole with or without retinal detachment, peripapillary deformation, dome-shaped macula, choroidal/scleral thinning, myopic choroidal neovascularization (CNV), and glaucoma. The author made a beautiful job in summarizing all those complications; however, he/she did not mention myopic subretinal hemorrhage (mSH).
Also termed submacular hemorrhage, mSH is a specific complication of degenerative myopia occurring in approximately 3% of highly myopic eyes.2 It is believed that mSH originates from rupture of Bruch membrane/choriocapillaris and represents the precursor of lacquer cracks.3 Notably, mSH takes place in the absence of CNV and these two entities should not be misdiagnosed with each other. Although mSH occurs in younger patients, the differentiation from CNV may be challenging because the visual acuity, refractive error, and type of hemorrhage are not contributory.4 The absence of leakage at fluorescein angiography suggestive of CNV is an important diagnostic clue. On optical coherence tomography, mSH appears as subretinal hyperreflective material. Dansingani et al5 demonstrated that optical coherence tomography angiography allows for the differentiation of vascular from avascular subretinal hyperreflective material and, therefore, it could represent an adjunctive diagnostic tool to distinguish mSH from myopic CNV.
The onset of mSH is characterized by sudden visual acuity reduction, which usually recovers spontaneously with blood disappearance.3 Although defined as a relatively benign condition, visual recovery may be limited even after blood reabsorption in case of interruption of the ellipsoid zone and external limiting membrane.