Niveau (Level) as a Key Predictor of the Absence of Macular Hole in Subinternal Limiting Membrane Hemorrhage Secondary to Retinal Arterial Macroaneurysm Rupture.

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.