COMPARISON OF FOVEA-SPARING (BUTTON-HOLE) AND CONVENTIONAL INTERNAL LIMITING MEMBRANE PEELING IN RETINAL ARTERIAL...

Area of Science:

• Ophthalmology
• Retinal Surgery
• Vitreoretinal Interface Disorders

Background:

• Retinal arterial macroaneurysm rupture can cause significant visual impairment due to associated hemorrhages.
• Internal limiting membrane (ILM) peeling is a common surgical step in managing various retinal conditions.
• Sub-ILM hemorrhage and subretinal hemorrhage present unique challenges in visual recovery.

Purpose of the Study:

• To compare the surgical outcomes of foveal-sparing ILM peeling (button-hole technique) versus conventional ILM peeling.
• To evaluate visual and anatomical results in patients with retinal arterial macroaneurysm rupture.
• To assess the incidence of postoperative macular hole formation between the two ILM peeling techniques.

Main Methods:

• Retrospective review of 42 eyes undergoing vitrectomy for retinal arterial macroaneurysm rupture with sub-ILM and subretinal hemorrhage.
• Patients were divided into conventional ILM peeling (n=22) and foveal-sparing ILM peeling (button-hole, n=20) groups.
• Subgroup analyses were performed based on preoperative or intraoperative macular hole detection.

Main Results:

• Both groups demonstrated significant visual acuity improvement (P < 0.001).
• Foveal-sparing ILM peeling resulted in significantly better postoperative visual acuity (P = 0.039).
• Macular hole formation occurred in 22.7% of the conventional group, but none in the button-hole group (P = 0.049).

Conclusions:

• Foveal-sparing ILM peeling (button-hole) yields superior visual and anatomical outcomes.
• The button-hole technique significantly reduces the incidence of postoperative macular holes.
• This technique is advantageous for patients with retinal arterial macroaneurysm rupture and associated hemorrhages.