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Niveau (Level) as a Key Predictor of the Absence of Macular Hole in Subinternal Limiting Membrane Hemorrhage
Yuki Otsuka1, Miou Hirose1, Hideyasu Oh1
1Department of Ophthalmology, Hyogo Prefectural Amagasaki General Medical Center, Kyoto University, Amagasaki, Hyogo, Japan.
Purpose:
To investigate the risk factors of macular hole (MH) in patients with retinal arterial macroaneurysm (RAM) rupture.
Design:
Retrospective observational cohort study.
Participants:
We reviewed the records of patients with RAM rupture who underwent pars plana vitrectomy at Hyogo Prefectural Amagasaki General Medical Center between December 2015 and December 2024. We included consecutive cases with subinternal limiting membrane (sub-ILM) hemorrhage covering the fovea and with unclear MH status on OCT before surgery.
Methods:
The following data were extracted from the medical records: age, sex, duration between onset and first examination or surgery, axial length, preoperative best-corrected visual acuity, systemic hypertension and diabetes mellitus, oral administration of antiplatelets and anticoagulants, RAM location (superior or inferior to the fovea), distance from the RAM to the fovea, presence of a niveau (fluid level) in sub-ILM hemorrhage, fluffy sign, foveal mountain peak sign, and type of surgical procedure (vitrectomy system [25/27 gauge], combined cataract surgery, subretinal tissue plasminogen activator [t-PA] injection, and sulfur hexafluoride gas tamponade).
Main Outcome Measures:
The presence of MH in patients with RAM rupture.
Results:
Thirty-nine patients were included in this study. Macular hole was observed in 14 patients (35.9%). Fluid level in sub-ILM hemorrhage was observed in 92.0% and 14.3% of the patients without and with MH, respectively. The absence of fluid level was associated with the presence of MH (P < 0.01). Subretinal injection of t-PA was more frequently administered to patients with MH (P = 0.027). However, multivariate logistic regression analysis revealed that only fluid level in sub-ILM hemorrhage was significantly associated with MH development (P < 0.01; risk ratio = 0.0033; 95% confidence interval = -12.1 to -2.6).
Conclusions:
The absence of fluid level in sub-ILM hemorrhage was associated with MH development. Fluid level in sub-ILM hemorrhage is a useful predictive factor of MH in patients with RAM rupture.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
Insights
The absence of a fluid level in sub-internal limiting membrane hemorrhage is a key indicator for macular hole development following retinal arterial macroaneurysm rupture. This finding aids in predicting macular hole risk in affected patients.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Vascular Ophthalmology
Background:
- Retinal arterial macroaneurysm (RAM) rupture can lead to significant vision loss.
- Sub-internal limiting membrane (sub-ILM) hemorrhage is a common complication of RAM rupture.
- Macular hole (MH) formation is a potential complication that requires further investigation.
Purpose of the Study:
- To identify risk factors associated with the development of macular holes (MH) in patients experiencing retinal arterial macroaneurysm (RAM) rupture.
- To evaluate the predictive value of specific clinical signs for MH development post-RAM rupture.
Main Methods:
- Retrospective observational cohort study including patients with RAM rupture and foveal sub-ILM hemorrhage.
- Data collected included patient demographics, clinical history, ocular parameters, and surgical interventions.
- Optical coherence tomography (OCT) was used to assess macular status pre-operatively.
Main Results:
- Macular hole (MH) was observed in 35.9% of the 39 included patients.
- Absence of a fluid level (niveau) in sub-ILM hemorrhage was significantly associated with MH development (p < 0.01).
- Subretinal tissue plasminogen activator (t-PA) injection was more frequent in MH patients, but fluid level absence was the sole significant predictor in multivariate analysis.
Conclusions:
- The absence of a fluid level in sub-ILM hemorrhage is a significant predictor of macular hole development after RAM rupture.
- Identifying the absence of fluid level in hemorrhage can help anticipate MH risk in patients with RAM rupture.
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