Management of a Macular Hole Following Retinal Arterial Macroaneurysm Rupture

Patient: Female, 60-year-old Final Diagnosis: Macular hole following retinal arterial macroaneurysm rupture Symptoms: Sudden loss of central vision Medication: — Clinical Procedure: 25-gauge pars plana vitrectomy Specialty: Ophthalmology OBJECTIVE: Unusual clinical course BACKGROUND: We report the successful treatment of a macular hole (MH) secondary to a retinal macroaneurysm (RAMA) rupture by pars plana vitrectomy (PPV) and autologous transplantation of an internal limiting membrane (ILM) during primary surgery. CASE REPORT: A 60-year-old woman presented with a sudden loss of central vision in her right eye. Fundus examination revealed a large sub-ILM hemorrhage involving the macula in her right eye. We performed 25-gauge PPV and ILM peel overlaying the hemorrhage. A ruptured RAMA next to the inferotemporal branch of the central retinal artery, MH, and subretinal hemorrhage were discovered. Part of the subretinal blood clot was removed through the MH. ILM was then further peeled off outside vascular arcades and transplanted as a free flap into the MH. At the end of surgery, 10% C3F8 gas was instilled as tamponade. Postoperatively, we observed anatomical closure of the MH, restoration of outer retinal layers, and improvement of visual acuity. During the follow-up period, the patient also had cataract surgery. Two years after the vitrectomy, the MH remained closed, with visual acuity improved to 10/20. CONCLUSIONS: Autologous ILM transplantation during primary PPV can be an effective surgical approach for treatment of MH related to ruptured RAMA in selected cases.