Closure of a macular hole associated with a retinal arterial aneurysm without surgical intervention

To report a case in which a macular hole (MH) associated with a ruptured retinal arteriolar aneurysm (RAM) closed without surgical intervention.

A 65-year-old woman presented complaining of sudden visual loss due to vitreous hemorrhage in the left eye. Correctable visual acuity in the left eye was 2/100 at the initial visit. Three weeks later, the vitreous hemorrhage had resolved, revealing an MH, serous retinal detachment, and subretinal hemorrhage associated with a ruptured RAM. Laser photocoagulation was applied to the RAM to promote absorption of the subretinal fluid. Two months after onset, the MH closed with resolution of the exudative retinal lesions and recovery of vision to 20/60.

The present case indicates that closure of an MH can take place within a couple of months without surgical intervention. This suggests that observation without surgical intervention may be advocated when an MH is associated with a ruptured RAM and massive subretinal hemorrhage spares the macula.