Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
Macular sub-ILM hemorrhage as a favorable prognostic factor in ruptured retinal arterial macroaneurysm.
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Oka Yukako, Ishikura Masaharu, Ooto Sotaro, Kawamura Hikaru, Ogino Ken
Аннотация
PURPOSE: To examine the relationship between macular sub-internal limiting membrane (sub-ILM) hemorrhage, foveal subretinal hemorrhage (SRH), and final visual acuity in ruptured retinal arterial macroaneurysm (RAM).
METHODS: This retrospective study included 32 consecutive eyes with ruptured RAM. SRH beneath the ruptured RAM caused visual loss requiring treatment. Patients underwent pars plana vitrectomy (PPV) with sulfur hexafluoride (SF₆), PPV alone, or SF₆ alone. Foveal SRH and macular sub-ILM hemorrhage were recorded. Multiple linear regression evaluated associations of foveal SRH and macular sub-ILM hemorrhage with final logMAR visual acuity.
RESULTS: Mean age was 79.0 ± 7.4 years. Mean logMAR acuity improved from 1.64 ± 0.46 to 0.79 ± 0.55 (P < 0.001). Foveal SRH was present in 18 eyes and macular sub-ILM hemorrhage in 15. Macular sub-ILM hemorrhage was inversely associated with foveal SRH (P = 0.031; odds ratio, 0.15). Final logMAR acuity was worse with foveal SRH (1.12 ± 0.45 vs. 0.37 ± 0.36; P < 0.001) but better with macular sub-ILM hemorrhage (0.45 ± 0.42 vs. 1.09 ± 0.48; P = 0.002). Regression showed foveal SRH predicted worse acuity (β = +0.57, 95% CI [+ 0.27, + 0.88], P < 0.001), whereas macular sub-ILM hemorrhage predicted better acuity (β = -0.39, 95% CI [- 0.70, - 0.09], P = 0.013; R² = 0.567).
CONCLUSIONS: In ruptured RAM, macular sub-ILM hemorrhage was inversely associated with foveal SRH and remained a favorable prognostic factor. A mechanical interaction between retinal layers, in which macular sub-ILM hemorrhage displaces subretinal blood away from the fovea, may have contributed to the better visual outcome.
METHODS: This retrospective study included 32 consecutive eyes with ruptured RAM. SRH beneath the ruptured RAM caused visual loss requiring treatment. Patients underwent pars plana vitrectomy (PPV) with sulfur hexafluoride (SF₆), PPV alone, or SF₆ alone. Foveal SRH and macular sub-ILM hemorrhage were recorded. Multiple linear regression evaluated associations of foveal SRH and macular sub-ILM hemorrhage with final logMAR visual acuity.
RESULTS: Mean age was 79.0 ± 7.4 years. Mean logMAR acuity improved from 1.64 ± 0.46 to 0.79 ± 0.55 (P < 0.001). Foveal SRH was present in 18 eyes and macular sub-ILM hemorrhage in 15. Macular sub-ILM hemorrhage was inversely associated with foveal SRH (P = 0.031; odds ratio, 0.15). Final logMAR acuity was worse with foveal SRH (1.12 ± 0.45 vs. 0.37 ± 0.36; P < 0.001) but better with macular sub-ILM hemorrhage (0.45 ± 0.42 vs. 1.09 ± 0.48; P = 0.002). Regression showed foveal SRH predicted worse acuity (β = +0.57, 95% CI [+ 0.27, + 0.88], P < 0.001), whereas macular sub-ILM hemorrhage predicted better acuity (β = -0.39, 95% CI [- 0.70, - 0.09], P = 0.013; R² = 0.567).
CONCLUSIONS: In ruptured RAM, macular sub-ILM hemorrhage was inversely associated with foveal SRH and remained a favorable prognostic factor. A mechanical interaction between retinal layers, in which macular sub-ILM hemorrhage displaces subretinal blood away from the fovea, may have contributed to the better visual outcome.