Incidence of macular hole in patients undergoing pars plana vitrectomy for submacular hemorrhage

TL;DR

This study finds that macular holes occur more often during vitrectomy for submacular hemorrhage caused by retinal arterial macroaneurysm rupture compared to age-related macular degeneration.

Contribution

The study reports a novel comparison of macular hole incidence in two distinct submacular hemorrhage etiologies during vitrectomy.

Findings

Macular holes occurred in 17.9% of retinal arterial macroaneurysm cases but not in age-related macular degeneration cases.

Subretinal t-PA injection was associated with a 40% macular hole development rate in retinal arterial macroaneurysm cases.

All macular holes were identified intraoperatively and successfully closed during the same procedure.

Abstract

To investigate the incidence of macular hole (MH) during pars plana vitrectomy (PPV) for submacular hemorrhage (SMH) due to either retinal arterial macroaneurysm (RAM) rupture or age-related macular degeneration (AMD).

We retrospectively evaluated 47 eyes of 47 patients with SMH due to RAM rupture or AMD who underwent PPV. The presence or development of MHs was confirmed intraoperatively by the surgeon. We compared the incidence of MH between the RAM and AMD groups.

In the RAM group, a MH was found in five of 28 (17.9%) eyes, and a MH was developed in three eyes by the surgical procedure. In the AMD group, there was no MH. All MHs were identified intraoperatively and closed by the same surgical procedure. In the RAM group, subretinal tissue plasminogen activator (t-PA) injection was performed in 12 eyes. Of the 12 eyes, two developed an MH before t-PA subretinal injection. Of the remaining 10 eyes, four (40%) developed an MH intraoperatively or postoperatively.

MHs are complications of PPV for SMH that occur more frequently in patients with SMH due to RAM rupture than in patients with SMH due to AMD.

Figures