Visual outcome after vitreous, sub-internal limiting membrane, and/or submacular hemorrhage removal associated with...

Ruptured retinal arterial macroaneurysms (RAM) can bleed into the various spaces of the eye. The hemorrhage of the inner layer conceals hemorrhage of the outer layer, making it difficult to diagnose the distribution of hemorrhage accurately and to predict the prognosis in clinical examinations. The objective of this study was to examine the clinical features and prognosis of ruptured RAM on the basis of surgical observations.

Retrospective review of 33 eyes of 31 patients with impairment of visual acuity due to hemorrhage from a ruptured RAM, who had undergone pars plana vitrectomy. A study of the location of hemorrhage was made from the preoperative fundus photographs and video of the surgical procedure.

Hemorrhage from the RAM was present in two or more locations, consisting of the vitreous cavity, beneath the internal limiting membrane (sub-ILM), or the subretinal space in all but one eye. Sub-ILM hemorrhage was presented in the macular region in 22 of the 27 eyes presenting with sub-ILM hemorrhage (81%). Submacular hemorrhage was only detected when sub-ILM hemorrhage removed during surgery in 12 of the 22 eyes (55%) with sub-ILM hemorrhage. The preoperative VA ranged from hand motion to 0.1, while postoperative VA improved 0.01 to 1.0 (average: 0.2, paired t-test, P<0.01). The VA was poor in eyes with dense submacular hemorrhage, while it was good in eyes with other hemorrhage.

The effects of vitrectomy were influenced by the location of hemorrhage from the RAM. The VA was poor in eyes exhibiting dense submacular hemorrhage. However, since hemorrhage from a RAM was present at various levels within the eye, it was difficult to evaluate the amount of submacular hemorrhage prior to surgery.